Professional Documents
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Exocad User Manual
Exocad User Manual
2023–07–04
User Manual
exoplan
Rx Only
exocad.com 2797
User Manual by exocad GmbH
© 2017–2023 exocad GmbH
exocad GmbH
Rosa-Parks-Str. 2
64295 Darmstadt
Germany
phone: +49-6151-629489-0
fax: +49-6151-629489-9
info@exocad.com
exocad.com
Document version
exoplan.3.1_User_Manual_en, 2023–07–04
Product version
exoplan 3.1 Rijeka
t.me/Dr_Mouayyad_AlbtousH
exoplan — User Manual
Content
1 General Information 7
1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.2 Indications for Use / Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.3 Clinical Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.4 Indications and Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.5 Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.6 Units and Conventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.7 Hardware Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.8 Software Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
1.9 Software Installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
1.10 Software Activation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
1.11 Input Data and Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
1.12 Navigating in 3D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
1.13 Color Scheme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2 Launching exoplan 16
3 Loading a Scene/Project/Scan 17
3.1 Loading a Scene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.2 Loading a Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.3 Loading a Scan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
3.4 Importing an Implant Planning Result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
5 DICOM Control 24
5.1 Data Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
5.2 View Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
5.3 Surface Generation Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
9 CT-to-Mesh Alignment 47
9.1 Interface Elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
9.2 3-Point Alignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
9.3 Best Fit Alignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
9.4 Transformation of Objects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
9.5 Options to Improve the Best Fit Alignment Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
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10 CT-to-CT Alignment 61
10.1 Extracting a Mesh from the Prosthesis CT Dataset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
10.2 Evaluating the CT-to-CT Alignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
10.3 Manual Marker Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
13 Sinus Segmentation 77
13.1 Interface Elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
13.2 Step-by-Step . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
13.3 Manually editing collision objects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
16 Implant Positioning 97
16.1 Interface Elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
16.2 Selecting an Implant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
16.3 Initially Positioning an Implant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
16.4 Moving/Rotating an Implant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
16.5 Implant Positioning Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
16.6 Selecting a Sleeve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
16.7 Positioning a Sleeve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
16.8 Anchor Pin Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
16.9 Finalizing the Implant Positioning step . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
17.3 Generating Provisional Implant Planning Result Files for Individual Implants . . . . . . . . . . . . . . . . . . . 120
17.4 Errors During Implant Planning Result Files Generation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
17.5 Selecting the Workflow After Generating Implant Planning Result Files . . . . . . . . . . . . . . . . . . . . . . 121
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23 Views 172
23.1 Main View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
23.2 Secondary Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
23.3 Axis-oriented Views: Axial, Sagittal, Coronal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
23.4 Panoramic Curve-Based Views: Curve Cut, Curve Tangent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
23.5 Panorama View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
23.6 Implant-based Views: Implant Cross 1 & 2, Implant Axial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
23.7 User-defined View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
23.8 View Presets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
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24 Menus 187
24.1 Main Toolbar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
24.2 Expert Toolbar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
24.3 Context Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
25 Controls 189
25.1 Group Selector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
25.2 Implant Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190
25.3 DICOM Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
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26 Tools 194
26.1 Measurement Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
26.2 Add/Remove Mesh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
26.3 Annotations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
26.4 Screenshot and Image Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
26.5 Aligning Meshes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
26.6 Show Project in Explorer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
26.7 Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
26.8 About . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
27 Appendix 212
27.1 System Exceptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
27.2 DICOM Control: Information in Data Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
27.3 Axial and View Direction Purposes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
27.4 Libraries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
27.5 Collisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
27.6 Implant Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
27.7 Planning Result Files . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
27.8 Mesh Types for Loading in exoplan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
27.9 Saving Meshes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
27.10 Shortcuts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
27.11 Notification History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
27.12 Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
27.13 Safety Warnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
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exoplan — User Manual
1 General Information
WARNING
Federal Law (USA) restricts the sale of this device to or on the order of a physician, dentist, or li-
censed practitioner.
Any serious incident that occurs in relation to this device must be reported to the manufacturer
and the competent authority of the member state in which the user and/or patient is established.
WARNING
A warning alerts the user to potential harm or a potentially hazardous situation and may provide
control measures.
HINT
A hint provides a general suggestion for performing a workflow step or solving a potentially prob-
lematic situation.
NOTE
A note is a brief comment on a particular workflow step or an explanation of accuracy.
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1.1 Introduction
exoplan is a pre-operative software application for planning the position of one or more implants based on imported and
aligned CT data and 3D surface scans. exoplan output data can be used for creating surgical guides (third-party fabrication),
or be imported into other software (e.g., exocad DentalCAD) for designing virtual restorations. Using exoplan requires the
necessary expertise in implant dentistry.
exoplan allows the visualization of implants and other planning objects (such as mandibular canals and tooth models) within
the visualized 3D volume data and in various 2D views, allowing dental professionals (e.g., implantologists), to precisely plan
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positions, orientations, types, and sizes of implants. Safety features, such as collision detection, density visualization, and
safety distance, reduce the risk of harm to the patient to the lowest possible degree.
1.4.2 Contraindications
exoplan is not for diagnostic purposes.
exoplan is not intended for edentulous patients in need of a bone-supported surgical guide.
exoplan only supports the planning of treatments for adults.
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This version of exoplan does not support the planning with zygomatic implants.
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WARNING
exoplan must only be used by qualified professionals. Using exoplan and surgical guide de-
sign and its features as well as the manufacturing of surgical guides without the necessary
medical knowledge in dentistry and professional diligence can lead to serious injuries of the
patient during the surgical implanting process, such as a permanent injury of the mandibular
nerve, a vessel, sinus, or healthy teeth.
exoplan must not be used by users with a physical handicap in color perception (e.g., color-
blind). exoplan users must be physically able to distinguish colors used for the display of ob-
jects (e.g., colors used for collisions and bone densities).
Good dental practice must be followed and the patient must be in a suitable and healthy con-
dition before starting the implant surgery (e.g., no periodontal disease on the patient’s denti-
tion).
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RAM: 8GB
Graphics: Nvidia or AMD Radeon dedicated GPU with at least 2 GB video RAM or better, OpenGL 4, DirectX 11.1, Shader
Model 5 and a graphics driver dated August 2017 or newer
Screen resolution: 1080p (1920x1080, or higher), if a DPI setting of 100% is used. If you use a higher DPI setting, a higher
resolution is required.
Power: 450 Watt
Peripherals/Human Interface devices (HID):
Standard computer keyboard required
Standard computer mouse required
3D mouse (3D connexion) optional/supported
Please see here for supported 3D mice: http://www.3dconnexion.com/products/spacemouse.html. Any special LED/display-
powered 3D mouse macros/buttons are not supported.
A free USB slot is required to connect the USB license copy protection dongle (HID device).
Please verify the display quality of your monitor before using exoplan, e.g., by using the SMPTE test image.
WARNING
Ensure to use only the recommended hardware, drivers, operating system, and software applica-
tions (e.g., PDF reader), such as graphics adapter, and that your graphics and monitor settings as
well as the light conditions of your work environment are configured in an optimal way.
WARNING
It is suggested to use the version of the graphics adapter driver that was current when exoplan was
released. Furthermore, disable automatic driver updates to avoid newer drivers that could have
potential negative side effects to the performance and stability of exoplan. Modification and/or
corruption of the software installation may lead to dangerous results in the implant planning pro-
cess and the design of a surgical guide with hazardous impact for the surgical implanting process.
Take appropriate measures to protect the exoplan software installation, and the patient data included, from unauthorized
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access and malware or viruses. Ensure that backups of all relevant/critical data are available.
Choose an appropriate dpi scaling. The dpi scaling is a setting of the Windows Control Panel. It generally influences the size
of windows, text, and icons. Choose a dpi scaling that displays exoplan menus and controls in a comprehensible size, so that
they do not cover essential parts of the main view.
The exoplan user manuals are available on the exocad website.
WARNING
Ensure that the DICOM series has a sufficient spatial resolution, an acceptable accuracy, and is not
blurred (e.g., due to patient movement during acquisition).
WARNING
The relevant anatomical structures must be sufficiently visible in the 3D CT data to proceed with
implant planning. e.g., the mandibular nerve must be visible in the mandible. In maxillae, the an-
terior palatine nerve and the maxillary sinus floor must be visible. Insufficiently visible anatomical
structures in the 3D CT data may lead to an erroneous planning process and thus may cause per-
manent injury of the patient.
NOTE
Use data for exoplan from a trustable source only.
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HINT
If loading the DICOM data fails, please examine the DICOM data requirements listed below and
make sure that the input data meets these requirements.
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exoplan uses volumetric DICOM data for a visual representation of the dentomaxillofacial region.
The following requirements must be met:
The DICOM dataset must contain at least one study.
The study within one DICOM dataset must contain at least one image series.
A DICOM series must contain at least two images.
The slices in a DICOM series must be equidistant.
Data with gantry tilt cannot be used in exoplan.
The SOP Class UID of the DICOM series must be Enhanced CT Image Storage or CT Image Storage. This means only CT or
conebeam CT data can be used.
The DICOM modality must be CT (Computed Tomography), DX (Digital Radiography), or CR (Computed Radiography). Load-
ing of other DICOM modalities, e.g., MRI is not possible.
exoplan will refuse to load the data if any of these requirements is not met and the user will be informed in a dialog that the
DICOM data cannot be loaded and therefore cannot be used for the implant planning process.
The following recommendations should be considered when acquiring the patient’s DICOM data:
During CT data acquisition, focus on achieving the highest possible resolution with as less artifacts as possible. Try to
reduce the potential noise caused by metal artifacts or scattering by e.g., scanning the patient in a tilted position.
Ensure that the complete patient anatomy and structures at risk (e.g., nerves or sinus cavity) necessary for the implant-
planning process are visible in the resulting DICOM series.
exocad recommends scanning the patient in not completely closed jaw position. This is helpful in the CT data align-
ment step (see Chapter 9).
All of the above requirements and recommendations also apply when capturing the prosthesis DICOM data for the dual scan
protocol, with the exception of recommendations regarding anatomical risk structures. Additionally, the following require-
ments apply for the dual scan workflow:
When acquiring the patient’s DICOM data, ensure that the patient wears a prosthesis fitted with radio-opaque markers
(a radiographic guide).
Ideally, the DICOM data of the radiographic guide (the prosthesis fitted with radio-opaque markers), should be acquired
directly after the acquisition of the patient’s DICOM data, to ensure that the prosthesis data matches the patient data.
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exoplan allows DICOM datasets with certain issues (nonconformance to the DICOM standard or other unfavorable proper-
ties, e.g., insufficient image resolution) to be loaded. The following types of datasets can be loaded by exoplan, but you will
have to confirm that you understand the risks when proceeding to load them for further usage:
Datasets defined as Enhanced CT Image Storage SOP class (UID: 1.2.840.10008.5.1.4.1.1.2.1, DICOM tag <0008,0016>) that
are saved as single-frame, instead of multi-frame.
Datasets where the third value of the Image Type parameter (DICOM tag <0008,0008>) is not defined as AXIAL or
VOLUME but as something else which is not defined as a valid value for this parameter (e.g., REFORMATTED) according
to the DICOM standard.
Datasets where the maximum slice positioning error (i.e., the distance deviation between two consecutive slices) is
more than 1 % of the current slice thickness (z-spacing). Note that if the distance deviation is higher than 0.006mm,
exoplan will refuse to load the data.
Datasets where there is an inconsistency between the listed UIDs in the DICOMDIR file and the UIDs of the correspond-
ing single-frame files.
Datasets where the size of a voxel as per Pixel Spacing (DICOM tag <0028,0030>) and Slice Thickness (DI-
COM tag <0018,0050>) in the DICOM series to load is larger than 0.6 mm in any of the dimensions.
Datasets with the modality CR (Computed Radiography).
After loading a DICOM dataset that contains at least one of these issues, a warning dialog appears that lists all detected
DICOM issues. It shows information about the affected dataset 1}
m , the issue type 2}
m, and a detailed issue description 3}m
(see Figure 1.1).
1}
m 2}
m 3}
m
4}
m
5}
m
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Click Continue anyway 4} mto load the dataset. A red, clickable indicator will be shown in the DICOM Control (see Figure
1.2). Click Load another dataset 5}
m to close the dialog and load another dataset.
Click the indicator in the DICOM Control 6}m to show an overview dialog listing all isues with the DICOM dataset (see Chapter
5 for a detailed description of the DICOM Control). The indicator is permanently shown in the DICOM Control, which is also
the case when a scene file with an affected DICOM dataset is loaded or when implant planning information with an affected
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6}
m
The implant planning report (see Chapter 17) and the surgical report (see Chapter 18.14) will also contain a warning with
information that the DICOM series had a user-accepted issue.
WARNING
When loading a DICOM series and an optical scan, ensure that the series and the scan belong
to the same and current patient.
Ensure that the data quality of optical scans used in exoplan is sufficient for implant planning.
An optical scan used in the implant planning process must cover all relevant areas, such as remaining teeth.
exocad recommends using a recently produced optical scan, so that it shows the current tooth situation of the patient.
If you are loading a scan (antagonist scan, waxup, pre-op etc.), verify that you have loaded the correct scan.
1.12 Navigating in 3D
Function Description
Hold right mouse button and drag Rotate the view around the rotation center (center of currently available scene
objects by default)
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Right-click outer frame and drag Rotate the view around the view axis
Click middle mouse button / mouse Center view and set new rotation center
wheel
Hold both mouse buttons and drag Move the view freely
Page up, page down Rotate the view horizontally around the pivot point
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SHORTCUTS
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2 Launching exoplan
Launch exoplan either by running the ImplantPlanning.exe file in your exoplan installation folder, or via an external
software (e.g., exocad DentalDB).
Using the main toolbar (see Chapter 24.1) or the context menu (see Chapter 24.3), you can load a scene, a project , or a scan
(see Chapter 3). You can also open the DICOM Control to visualize a DICOM series (see Chapter 4).
1}
m 2}
m
1}
mMain view
2}
mMain toolbar (see Chapter 24.1)
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3 Loading a Scene/Project/Scan
The options to load a scene/project/scan are only available if no project/scene is currently loaded in exoplan. Scenes/projects/scans
can be loaded as described in chapters 3.1, 3.2, and 3.3, or by Drag&Drop into to the main view.
Note that in case of an error during planning, you need to restart exoplan in order to load a project/scene file.
You can load scene files saved by a previous version of exoplan. Scene files saved by a future version of exoplan will not be
loadable. When loading scene files, exoplan checks if library parts (implant, sleeve, drill...) that are contained in the scene
were originally loaded from libraries that are not supported any more or are not correctly signed due to any other reason. In
such cases, exoplan will either display a message box or a notification that lists all these parts.
SHORTCUT
CTRL + L: Open explorer window to load a project
If scene files exist for the project you have selected, exoplan prompts you to decide if you want to load a scene file (select
from the list) or to start the planning from scratch.
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You can still load a project after you have visualized a DICOM series using the DICOM Control (see Chapter 4).
NOTE
If a CT alignment data file belonging to the project file exists and is named
<project name>-ctalignmentobject, this data file is automatically loaded with the project.
This is similar to a scan data file, but instead of a scan data file, a CT alignment object can be artifi-
cially created and may not be based on a 3D scan.
Supported file formats for CT alignment data files: STL (Binary or ASCII), OFF (Binary or ASCII), OBJ
ASCII, PLY.
If you import a tooth setup for the current tooth number(s), the step Place Model teeth (see Chapter 14) will not appear
in the Wizard workflow. Note that you can still initiate the Place Model Teeth step via Expert mode. If you start the Place
Model Teeth step via Expert mode, and have imported a tooth setup for the current tooth number(s) from a *.dentalCAD
scene file, exoplan will remove the imported tooth setup for the current tooth number(s).
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If the *.dentalCAD scene contains SmileDesign image parts, an additional custom view button Smile Design View is dis-
played above the view presets in the main toolbar (see Chapter 24.1). Click this button to align the camera so that it is per-
pendicular to the imported smile face image. Note that this button is disabled in the step Load Prosthesis CT Dataset.
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1}
m
2}
m
WARNING
Make sure that the optical scan is based on a recent physical model and/or was recorded recently.
Scans based on outdated information may not fit the patient’s anatomical situation or lead to in-
juries, complications, or additional surgery.
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NOTE
exoplan does not load implant planning files where the result of the alignment was stated to
be inaccurate.
If the imported implant planning information is missing information (e.g., the bone level height,
the panoramic curve, or the patient axes), exoplan will cancel the import and the current
project will be closed. As a workaround, you can open the latest planning scene associated
with the implant planning information file in your exoplan version and restart the output gen-
eration. Afterwards, import the newly created file again.
If the imported implant planning information contains any DICOM data issues, exoplan prompts
you to decide how to proceed as described in Chapter 1.11.1.
If the imported implant planning information contains an implant library, sleeve library, kit
library, or drill protocol library that is locally not available or unsigned or was originally un-
signed, exoplan displays a dialog that informs you about this issue. You can continue import-
ing the *.implantPlanningInfo file or cancel the import.
For projects where implants have been planned in both jaws, exoplan generates two
*.implantPlanningInfo files, both of which can be imported.
Subsequent loading of a patient’s DICOM dataset is only possible if the dataset has the same
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DICOM series UID as the one used for implant planning. This information is encoded in the
imported IPI-file.
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As basis of the implant planning process, you select and visualize a DICOM series recorded for your patient (see Chapter 1.11.1
for DICOM series requirements).
3}
m
1}
m
2}
m
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If you have loaded a project file containing the patient’s name, the dialog’s title will display it (see Figure 4.2).
2. Select the directory which contains the DICOM series you want to visualize:
Browse the directory in the navigation section 1}
m, or
drag a folder from a separate explorer window to the CT data analysis section 2}
m, or
paste the directory’s path into the navigation line 3}
m.
exoplan automatically analyzes the selected file directory for existing CT data. The content of subfolders is not considered
in this analysis.
HINT
You can set a default directory for searching for DICOM data in the exoplan settings. See chapter
26.7.
3. Select a DICOM series in the analysis section (selecting a study/patient is not possible). Click OK. The DICOM series is being
loaded (see Figure 4.5). You can abort the loading process by clicking Cancel loading.
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3}
m 2}
m 4}
m
1}
m
5}
m
1}
mMain view: DICOM series visualization (for view functions see Chapter 23.1.1)
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2}
mDICOM Control (see Chapter 5)
3}
mGroup Selector (see Chapter 25.1) with CT data group
4}
mSecondary views Axial, Sagittal, and Coronal (see Chapter 23.2)
5}
mWizard window (see Chapter 20)
Once you have loaded a project file, loaded a DICOM series and continue in the exoplan workflow, you cannot return to
the DICOM series selection step and thus cannot retrospectively select another series for the current planning.
If the project definition includes implants in both jaws, exoplan prompts you to select if you want to plan implants for the
upper jaw, lower jaw, or both jaws when you proceed to the next workflow step.
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5 DICOM Control
You can modify the visualization of the DICOM series using the options and settings in the DICOM Control. To show/hide the
DICOM Control, click DICOM Control in the main toolbar (see Chapter 24.1).
WARNING
Wrong visualization settings for the DICOM series may lead to undesired results of the implant
planning process with the consequence of seriously injuring the patient (mandibular nerve, sinus,
healthy tooth) in the surgical implanting procedure.
HINT
We recommend defining the density references as described in chapter 6. Subsequently, use the
buttons for Soft tissue, Bone and Tooth to quickly set the corresponding density value for the
current visualization.
You can reduce/extend the DICOM Control window using the icon v/> on the right.
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1}
m
2}
m
1}
mStructure of the CT dataset (patient, studies, series)
2}
mPatient/study/series information (depending on left-side selection)
5.1.1 Functions
Function Description
Select file set Open the DICOM Series Selection Dialog, for selecting a different series to load.
Load series Load the series currently selected in the CT dataset structure (left side).
Once you continue in the workflow, these functions will not be available anymore.
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Mode Description
Isosurfaces Visualizes the DICOM series as a surface generated from the CT data, precisely containing those
Chapter 5.2.1 voxels with a density value equal to a selected surface threshold value.
X-ray Visualizes the DICOM series in a way that simulates a conventional X-ray exposure, considering
Chapter 5.2.2 only those voxels with a density value higher than a given noise threshold value.
Solid The DICOM series is rendered as a solid cube. Each voxel on its face is grayscale-colored
Chapter 5.2.3 according to the local density value. You can cut the cube to visualize the area of interest.
Solid (natural) As with Solid mode, the DICOM series is visualized as a solid cube, but colored according to
Chapter 5.2.4 different density ranges. These ranges are defined as density references (see Chapter 6). Each
range has a different color. Additionally, you can set an edge contrast enhancement value.
Select a visualization mode by clicking the corresponding button at the top of the tab. Modifications for visualization param-
eters and options will be rendered in real-time in the main view.
5.2.1 Isosurfaces
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Option Description
Surface threshold Use this slider or type in a value to define the density value of the anatomical structure
displayed as a surface.
Soft Tissue, Bone, Tooth These buttons are deactivated if density reference values have not been defined in the
density references definition step (see Chapter 6). As soon as you have defined density
references, you can visualize the corresponding surfaces using these buttons.
You can add a second surface, for example to visualize an opaque bone structure as primary surface and a semi-transparent
soft tissue structure as secondary surface. If Semi-transparency is activated in the Options section, you cannot add a second
surface.
To add a second surface:
Step 1: Click Add second surface.
Step 2: Use the sliders Second surface threshold and Second surface transparency or type in values to define
the second surface threshold and opacity. You cannot define a second surface threshold value higher than the
primary surface threshold value.
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5.2.2 X-ray
Use the Noise threshold slider or type in a value to define which voxels are displayed in the X-ray visualization. Voxel data
lower than the specified value is not considered. This setting determines the contrast. It also applies to the X-ray visualization
mode of the panorama view (see Chapter 23.5) and determines its image contrast in the planning report PDF.
5.2.3 Solid
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Option Description
Activate solid highlighting By default, solid highlighting is deactivated. Check Activate solid highlighting to
activate the Highlight density slider.
Highlight density Use this slider to define a threshold value that determines which parts of the visible
anatomic structure are highlighted in red. All data values higher than the defined value
are highlighted. This coloring is also used in the planning report PDF’s images.
Solid Options: Hard to soft Use this slider to smooth the border between highlighted and unhighlighted regions
when solid highlighting is activated.
The solid highlighting settings also apply to the secondary views (see Chapter 23).
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Use the slider Edge Contrast Enhancement to change the edge contrast in the visible anatomical structure. The lower the
value, the lower the edge contrast.
Using the Current CT data window slider, you can define the range of data used for the visualization. These settings influ-
ence contrast and brightness in the Solid visualization mode and in secondary views (see Chapter 23.2.5). Using the triangle
icon, you can choose from available CT data window presets. Available presets are defined in the DICOM dataset. <Full
Range> is always available, which extends the CT data window to the full range of available data values.
Using the Brightness slider, you can adjust the brightness of the visualization. Using the Contrast slider, you can adjust the
contrast of the visualization.
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Available checkboxes:
Semi-transparency: Set the DICOM series visualization to half transparent. Deactivates the Add second surface
button in visualization mode Isosurfaces (see Chapter 5.2.1).
Use preview mode: Activated by default. In preview mode, the accuracy is reduced during camera movements or vi-
sualization parameter adjustments. If your PC is high-performative, you can deactivate the preview mode to maintain
highest possible accuracy during camera movements and slider adjustment.
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Clip
You can cut away a section of the DICOM series visualization in three directions from both sides by using the corresponding
range sliders or entering values.
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Function Description
Toggle look through Display only the front side of the surface.
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2}
m
3}
m
1}
m
4}
m
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1}
mMain view (see Chapter 6.1.1)
2}
mDICOM Control (see Chapter 6.1.2)
3}
mGroup Selector (see Chapter 6.1.3)
4}
mDefine Density References window (see Chapter 6.1.4)
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Function Description
Surface threshold Slider for defining the surface threshold for the isosurface visualization. It has the same
function as the corresponding slider in the DICOM Control (see Chapter 5.2.1). You can
use either slider for defining density references.
Soft tissue, Bone, Tooth Buttons for defining density references (see Chapter 6.2).
Threshold Button for defining the density threshold value. You can change the slider range using
the context menu (see Chapter 24.3).
Define Value Save value and continue with the next value type.
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Function Description
Reset View (Threshold) Reset the view and the sliders in the Clip section of the DICOM Control window to the
initial orientation/value.
Use suggested values on If checked, suggested values for each type will be applied when choosing to skip the
skip manual definition.
OK Complete the step, save all your settings, and close the window.
Cancel Abort the step and close the window. All changes made since you entered the density
references definition step will be discarded.
6.2 Step-by-Step
Step 1: Click the Soft tissue button in the Define Density References window.
Step 2: Set a density reference using the Surface threshold slider in the Define Density References window or in
the DICOM Control, so that the corresponding surface is visualized in the main view. exoplan will suggest values
based on previous projects. Alternatively, right-click the corresponding button in the DICOM Control and select
the appearing context menu option. The DICOM Control buttons allow you to quickly switch between the defined
surfaces, also in subsequent workflow steps.
Step 3: Define the density reference by clicking the corresponding button. A green checkmark appears when the value
type has been defined. The next value type will be selected automatically when you have defined a value.
Step 4: Repeat steps 2 & 3 for Bone and Tooth.
Step 5: Define a Threshold value for visually separating hard bone areas from softer areas by moving the Surface
Threshold slider or by entering a value. Voxels above the defined value will be displayed in blue, voxels below
the defined value will be displayed in red. In the implant positioning step (see Chapter 16), the colors will help you
avoid positioning an implant in an area which may be of insufficient density.
Define a value that leads to all bone and denser areas being blue. Figure 6.4 shows an example of the DICOM
series visualization with correctly defined density threshold. Bone and denser areas appear blue, all other areas
appear red.
Ensure all blue areas are always bone areas. Red areas can be bone areas, blue areas must be bone areas.
If you are working with a CT dataset, you can also enter the default values for the density references based on the Hounsfield
scale in the Define Density References window.
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(a) Soft tissue defined (b) Soft tissue and bone defined
(c) Soft tissue, bone, and tooth defined (d) Soft tissue, bone, tooth, and threshold defined
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Ensure that the density reference values are proportionate. You will not be able to
continue in the workflow with unproportional values. For instance, do not define
a higher value for the soft tissue than for the bone structure. If you define such
values, a warning section in the info section of the Define Density References
window prompts you to check the values.
When you have defined at least one density reference and confirm by clicking OK, an xml file is created, containing the
threshold value(s) you have specified. These values also apply to all future projects and the Wizard step Define Density
References will not appear again for future projects. Note that you can define to always show the step in the exoplan
settings (see Chapter 26.7).
The density threshold value you define in this step affects how implants
are displayed in the implant positioning step (see Chapter 16). In certain
views, the implant will be colored blue and red, as shown in Figure 6.5. The
coloring illustrates the density area at the current implant position.
Be aware that the colors are just indicators. If the implant is displayed
in blue, this does not mean that it is in a completely dense area and if
the implant is displayed in red, this does not mean that it is in an area of
low density.
WARNING
An incorrect density threshold value definition can impede the recognition of suboptimal implant
positions.
HINT
The density threshold value and the deduced visualization are only visual helpers for the implant
placement. Choose a conservative value (i.e., higher, more red than blue) if in doubt.
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1}
m
3}
m
2}
m
1}
mAxial view (see Chapter 7.1.1)
2}
mPanorama view (see Chapter 7.1.2)
3}
mDefine Panoramic Curve window (see Chapter 7.1.3)
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If the bone density reference value is defined (see Chapter 6), this value is used for the surface visualization of the DICOM
dataset. If the bone density reference value is not yet defined, the surface value currently set in the DICOM Control (see
Chapter 5) is used for the surface visualization of the DICOM dataset.
WARNING
Verify the correctness of the position and shape of the panoramic curve before proceeding in the
workflow.
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4}
m 5}
m
1}
m
2}
m
3}
m
Figure 7.2: Axial view - DICOM data with initial panoramic curve
1}
mPanoramic curve
2}
mDepth indication lines
3}
mDrag point for moving the panoramic curve (see Chapter 7.2)
4}
mOrientation indicators (patient perspective: R = right, L = left)
5}
mDrag point for changing the panoramic view depth
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By holding the right-mouse button and moving the mouse, you can move through the DICOM series visualization in axial
direction to find an appropriate cut position.
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m 2}
m
1}
m
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Function Description
Automatic Curve Detection Checkbox to toggle the automatic detection of the panoramic curve. Slice through the
CT data by holding the right-mouse button and moving the mouse. exoplan detects the
curve of the current slice after you release the mouse button.
X-Ray Noise Threshold Change the noise threshold value for the X-ray visualization of the panorama view. This
slider is also available in the visualization settings menu of the panorama view (see
Chapter 23.2.1).
Panoramic view depth Change the panoramic view depth. The view depth is indicated by yellow margin lines
next to the panoramic curve.
Reset Deactivate the automatic curve detection and reset the curve to the default initial state.
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Directions Change axial and view direction to influence the panoramic curve generation. See
Chapter 21.1.
OK Complete the step, save all your settings, and close the window.
Cancel Abort the step, close the window. All changes made since you entered the panoramic
curve definition step will be discarded.
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You can define the panoramic curve for the whole jaw ridge (see Chapter 7.2.1) or only for parts of the jaw ridge (see Chapter
7.2.2). However, ensure that all case-relevant areas of the jaw are covered by the panoramic curve. Ensure that the labels
vestibular and oral fit the orientation of the patient’s jaw correctly.
7.2.1 Defining the Panoramic Curve for the Whole Jaw Ridge
Step 1: In the axial view, move along the axis through the CT data by holding the right-mouse button and moving the
mouse until you can clearly see the jaw ridge of the jaw you are planning the implant(s) for.
Step 2: Move the curve to the jaw ridge by clicking and dragging the drag point.
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Step 3: Define start and end point. Adjust the curve so that it fits the jaw ridge. Add points to the curve as needed by
clicking it. Drag and drop points to the desired positions.
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To delete a point, right-click it while holding it with the left mouse button. You can delete all points except for three: start
point, end point, and one point on the curve.
As result, the panoramic image shows a complete view of the patient’s dental situation (see Figure 7.5).
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Figure 7.5: Panoramic curve and image for the whole jaw ridge
7.2.2 Defining the Panoramic Curve for Parts of the Jaw Ridge
You can define the panoramic curve for a limited part of the jaw ridge. For example, only for one side of the jaw or only for
the relevant tooth area. Figure 7.6 shows the panoramic curve definition for these examples.
To define the panoramic curve for a part of the jaw ridge only, set the start and end point accordingly. Then adjust the curve
by setting points as described in Chapter 7.2.1.
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NOTE
Especially for partial head scans, it might be necessary to define the panoramic curve manually be-
cause automatic curve detection lacks crucial information of the dental arch and oral and vestibu-
lar orientation.
If defining the panoramic curve for a partial head scan, ensure that the oral and vestibular markers point to the correct direc-
tion. The direction varies with the orientation of the dental arch in the DICOM series.
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After you have defined the panoramic curve, you can align the CT data. CT
alignment is key to designing surgical guides after placing the implants.
Without CT alignment you will not be able to design surgical guides.
First, you need to choose a CT alignment workflow for each jaw in your
project. Click on the jaw 1}
myou want to select the workflow for and de-
1}
m
fine the workflow afterwards. The Wizard window Select CT Alignment
Workflow offers three possibilities:
2}
m CT-to-mesh alignment 2} m : Align CT data to an alignment object,
e.g an optical jaw scan. See chapter 9.
3}
m CT-to-CT alignment 3} m is typically referred to as Dual Scan Proto-
col in which a CT scan of a patient’s prosthesis is aligned to the pa-
4}
m
tient’s CT scan of the anatomy. exoplan will align the CT datasets au-
tomatically to each other, based on radio-opaque markers present in
both CT scans. See chapter 10.
Select the appropriate workflow for each jaw in your project. When a CT
alignment workflow is defined for a jaw, a green checkmark is displayed on
Figure 8.1: Select the CT data alignment the corresponding button. Confirm your selection with Next.
workflow
HINT
You can select a default alignment workflow in the exoplan settings. See chapter 26.7.
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9 CT-to-Mesh Alignment
WARNING
When alignment with the CT data is done using a particular alignment object which is not the jaw
scan, the user is responsible for assuring that the jaw scan used for surgical guide design is in cor-
rect relative geometrical position to the used alignment object.
With aligning the CT data to a jaw scan, you can include a high-quality surface scan that shows the (occlusion) surface and
shapes of teeth in the construction of surgical guides. For the alignment, use the same jaw scan that will be used for con-
structing the surgical guide.
Aligning the CT data consists of two steps:
3-point alignment (see Chapter 9.2)
Best fit alignment (see Chapter 9.3)
Additionally, you can perform a manual alignment after either of these steps (see Chapter 9.2.2).
WARNING
Aligning CT data is a sensitive process which must be performed accurately. This process includes
appropriate isosurface value settings, the accurate placement of points during the 3-point align-
ment step (see Chapter 9.2), and, if applicable, appropriate cropping of the CT mesh (see Chapter
21.5.2) and appropriate marking of feature regions (see Chapter 9.5.2). The alignment accuracy is
directly connected to the accuracy of surgical guides created from the jaw scan.
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HINT
Choose a density value of the isosurface visualization that represents the surface of the teeth in the
DICOM data (the predefined Bone value should be closest to this). Perform the 3-point Alignment
and Best Fit Alignment. Afterwards, carefully check the accuracy of the alignment by using the
color scale and evaluating the outline of the alignment object in the secondary views. If you are
not satisfied with the alignment, you can choose another density value and use the cropping and
brush selection functionality to select a region of interest for re-aligning the data.
NOTE
If the input data is optimal, the achievable accuracy of the combined 3-Point Alignment and Best
Fit Alignment is 0.2mm. The achievable accuracy is additionally limited by half of the maximum
voxel size of the DICOM data. E.g., if the maximum voxel size is 0.6mm, the achievable accuracy is
0.3mm. If the maximum voxel size is 0.2mm, the achievable accuracy is 0.2mm.
Input data is considered optimal if the DICOM data and the optical scan have been optimally ac-
quired while the density value has been selected so that the relevant areas of the DICOM data and
the optical scan represent the same surfaces.
3}
m 2}
m
1}
m
4}
m
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1}
mMain view - split screen (see Chapter 9.1.1)
2}
mDICOM Control (see Chapter 9.1.2)
3}
mGroup Selector (see Chapter 9.1.3)
4}
mCT Data Alignment window (see Chapter 9.1.4)
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WARNING
If you perform the CT data alignment step after model teeth have been loaded or positioned, an-
notations have been added, or collision objects have been loaded, you must decide if these should
be transformed (see Chapter 9.4).
HINT
In most scenarios, model teeth, annotations, and collision objects should be transformed as well
if they are placed in relation to the CT data.
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The CT Data Alignment window shown in Figure 9.2 consists of two tabs. The Align tab provides options and explanations
for performing the 3-point alignment, the Evaluation tab (see Chapter 9.2.1) is for evaluating a possible external alignment
(if no alignment has been performed in exoplan yet).
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Function Description
Three buttons for pairs of These buttons are highlighted during the point placement, indicating which pair of
points (red, green, blue) points you are currently defining.
Select additional floating Choose which objects should be transformed. See chapter 9.4 for a detailed description.
parts
Load from file Load additional CT-alignment objects. Select the desired alignment object from the
dropdown list afterwards.
Next / Apply Alignment Initiates the 3-Point-Alignment or the Best-Fit-Alignment, depending on your progress
in the CT-Alignment step.
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Back / Cancel Abort the CT data alignment step. All changes made since you entered the CT data
alignment step will be discarded. In Wizard mode, the Back button has the same
function, except only the last alignment will be discarded.
If you have loaded multiple objects that can be used for the alignment (e.g., via the Add/Remove Mesh tool, see Chapter 26.2),
a dropdown menu listing the available alignment objects is also part of the window.
Click the CT data and the alignment object to define three pairs of points, each pair consisting of one point on the CT data
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To reposition points, drag and drop the points. Alternatively, select the button for the corresponding pair of points and define
new positions by clicking the CT data / alignment object. To delete all defined points, click Clear Markers.
For the algorithms to work accurately, choose point positions that are not on a straight line and are not too close to each
other. The better you distribute your points, the better the results of the matching algorithms and the alignment result.
It helps if the CT data shows the patient with the jaws not fully closed, as it will enable you to set points more precisely. It
also means the results of the subsequent best fit alignment will be more precise, due to a larger tooth surface being available
compared to the fully closed jaw position.
Once you have positioned all points, click Next (Wizard mode) / Apply Alignment (Expert mode). The CT data is now aligned
to the alignment object. Once done, three secondary views are displayed by default: panorama view, Coronal view, and Curve
cut view.
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Use the main view to evaluate the 3-point alignment result. If the alignment object matches the CT data visualization prop-
erly and no larger deviations are visible (rotate the view to check all areas), the 3-point alignment result can be considered
precise enough to achieve an accurate result during best fit alignment (see Chapter 9.3).
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1}
m
In case the data is already aligned (e.g., externally) or you do not need an
alignment for further processing, you can skip the alignment process by
switching to the Evaluation tab.
By selecting one of the options provided in the Evaluation tab, you can
evaluate the CT data alignment before the 3-point alignment. If you select
2}
m an option, the CT data alignment step will be closed (3-point and best-fit
alignment will be skipped).
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5}
m Adjust the step size using the Define Step Size 4}
mslider.
When you are satisfied with the manual alignment, click Accept and Eval-
6}
m
uate 5}m . This will skip the best fit alignment and you will be prompted to
evaluate the manual alignment result as described in chapter 9.3.1.
To discard the manual alignment, click Undo manual alignment 6} m .
NOTE
The achievable repetitious accuracy for object movement is 0.2 mm. The achievable repetitious
accuracy for object rotation is 1 °.
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HINT
Press CTRL while Move CT alignment object is active to quickly switch to rotation mode.
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1}
m
2}
m
3}
m
Function Description
Crop CT mesh 1}
m, Reset CT Options to improve the alignment accuracy. See chapter 9.5.
m
}
mesh 2 , Mark Feature
Regions 3}
m
Back (Wizard mode) Discard the 3-point alignment to position the points again.
Cancel (Expert mode) Abort the CT data alignment step. All changes made since you entered the CT data
alignment step will be discarded. If you have already performed an alignment before,
the previous alignment result will be restored.
Discard Alignment (Expert Discard the complete alignment, return to the 3-point alignment step.
mode)
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Click Next (Wizard mode) / Start Best Fit Alignment (Expert mode). exoplan refines the fitting of the CT data with the
alignment object. This process may take several seconds depending on your hardware configuration. To stop the best fit
alignment, click Cancel.
When the best fit alignment is complete, the alignment object is displayed with colors (see Figure 9.8). The colors illustrate
the deviation of the alignment object to the currently displayed Isosurfaces visualization of the CT data. The color legend is
displayed in the CT Data Alignment window (see Figure 9.9).
Use the colors to evaluate the accuracy of the alignment result: If the areas which are clearly captured in both the CT data
and the alignment object (bone, teeth if you align to a jaw scan) appear blue (as in Figure 9.8), this is an indicator for the
alignment being accurate.
If gingiva areas in a jaw scan appear purple (deviation > 1 mm), that does not mean that the alignment result is not accurate.
The reason for this behavior is that the alignment object shows the gingiva very precisely, and the CT data does not properly
display gingiva areas.
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If you want to discard the best fit alignment result, select Discard
alignment 3} m . This will restart the CT-to-Mesh alignment step.
Figure 9.9: Options for evaluating the align-
ment result Check the accuracy of the CT-to-Mesh alignment by using the color
scale 4}
m . The color scale encodes the local distances between the
CT alignment object and the CT mesh extracted from the DICOM
dataset of the patient based on the current surface threshold value.
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If you cannot identify one single threshold value in the isosurfaces visualization that represents the alignment object features
sufficiently, you can accumulate several best fit alignment results by using different surface thresholds and choosing the first
option always.
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1}
m
2}
m
1}
mEdit CT Mesh (see Chapter 9.5.1)
3}
m 2}
mReset CT Mesh: Reset the CT mesh to its initial state
3}
mMark Feature Regions (see Chapter 9.5.2)
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1}
m 2}
m
For example, you can mark bone areas (including teeth) in an alignment object, since these are also clearly captured in the CT
data, whereas the gingiva captured in the alignment object is not captured properly in the CT data. Thus, the gingiva should
not be considered in the best fit alignment process and this area shall remain unmarked in the alignment object.
Click Mark Feature Regions to open the Surface Marker Tool window (see Figure 9.15).
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4}
m
1}
m
2}
m
3}
m
5}
m 6}
m
1}
mMark All: mark the entire alignment object
2}
mInvert Markings: marked regions become unmarked, unmarked regions become marked
3}
mDelete All Markings: delete all markings
4}
mBrush Size: change brush tool size
5}
mOK: confirm the marking result, close the Surface Marker Tool window
6}
mCancel: close the Surface Marker Tool window, discard all marking actions
Hold the left mouse button to draw the feature region on the alignment object. Adjust the brush size using the corresponding
slider, or by holding SHIFT and scrolling the mouse wheel. Hold SHIFT to invert the brush (the brush region will turn red).
After marking feature regions to be exclusively considered during the best fit alignment, you can return to the best fit align-
ment step by pressing OK.
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10 CT-to-CT Alignment
This Wizard step is initialized if you have selected CT-to-CT alignment in the previous Wizard step Select CT Alignment
Workflow (see Chapter 8). You can align the patient’s CT dataset to the loaded DICOM dataset of the patient’s prosthesis.
The main view is split in two synchronized screens visualizing the loaded CT datasets. You can set a surface threshold and
extract a mesh from the prosthesis CT dataset. Additionally, you can edit the mesh, e.g., to remove possible artifacts. The
mesh will be used for manual correction of the CT-to-CT alignment and can later be used for the guide design. exoplan only
supports the planning of treatments of edentulous patients if you complete the CT-to-CT Alignment.
Note that this step appears twice in the workflow if you are planning implants in both the upper and lower jaw.
HINT
Ensure that the patient’s CT data and the patient’s prosthesis CT data meet the requirements listed
in Chapter 1.11.
3}
m
1}
m 2}
m
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Step 1: Select the directory that contains the DICOM series you want to visualize. If you have loaded a project file
containing the patient’s name, the dialog’s title will display it (see Figure 4.2).
Browse the directory in the navigation section 1m
}, or
drag a folder from a separate explorer window to the CT data analysis section 2}
m, or
paste the directory’s path into the navigation line 3}
m.
Step 2: Load the prosthesis CT data in the DICOM series.
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exoplan automatically analyzes the selected file directory for existing CT data. The content of subfolders is not considered
in this analysis.
After loading the CT dataset of the prosthesis, exoplan opens the 2D sec-
tional views Axial, Sagittal and Coronal to support the evaluation of the
5}
m
selected surface threshold. In these 2D views, the prosthesis is colored ac-
cording to the currently selected threshold.
3}
m Activate the checkbox Finish step after extraction 3} mto skip
editing of the extracted mesh. Deactivate the checkbox if you want
4}
m
to be able to edit the mesh after extraction.
6}
m
Selecting Extract mesh 4} m will extract a mesh from the prosthesis
CT dataset. The mesh will be displayed in the main view and in 2D
sectional views as an outline overlaying the CT data of the prosthesis.
2}
m
1}
m
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Figure 10.3: Bad surface threshold setting Figure 10.4: Optimal surface threshold setting
1}
m: Make sure there are no holes in the contact surface to the gingiva.
2}
m: Avoid a disruptured ridge on the prosthesis mesh.
Click Next to initiate the automatic marker detection followed by the automatic alignment of the CT dataset to the extracted
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prosthesis mesh. You will be prompted to evaluate the alignment in the next Wizard step CT-to-CT Alignment. If the auto-
matic marker detection fails, you will be prompted to select the markers manually (see Chapter 10.3).
WARNING
If you perform the CT-to-CT data alignment step after annotations have been added or colli-
sion objects have been loaded, you must decide if these should be transformed (see Chapter
10.1.2).
In order to be able to mark the gingiva contact surface of a prosthesis correctly, it is essential
to use the proper threshold settings when extracting the patient’s prosthesis.
NOTE
You should compare the outlining of the extracted mesh with the CT data of the prosthesis in the
secondary views to see if it reflects the shape of the prosthesis accurately enough, especially in the
area of the contact surface with the gingiva.
In the Mesh Editing tab, you can edit the extracted prosthesis mesh using
2}
m 1}
m the Cropping tool 1} m (see Chapter 21.5.2) and the free-forming function-
ality 2}
m (see Chapter 21.5.1). Note that you can perform the free-forming
in both the main view and the secondary 2D views.
To restore the extracted CT prosthesis mesh to its original state, select Re-
store Mesh 3} m .
3}
m
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HINT
Use the tools in the Mesh Editing tab to remove mesh artifacts from the prosthesis mesh. Es-
pecially, remove floating or connecting mesh artifacts within the prosthesis mesh by using the
Cropping tool. This is described in detail in Chapter 18.9.1.
2}
m check the accuracy of the alignment. Selecting this option will finish the
CT-to-CT data alignment step and initiate the next Wizard step.
Completely discard the extracted mesh and the applied alignment by se-
lecting Completely discard extracted mesh and applied alignment 3} m .
This will restart the CT-to-CT data alignment step and you will be prompted
to load a prosthesis CT dataset again.
Figure 10.7: Evaluating the CT-to-CT Back (Wizard mode) / Undo marker alignment (Expert mode): Initiate the
Alignment manual marker detection step (see Chapter 10.3).
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4}
m Surface threshold patient 4} m: Slider to set the threshold for the
surface visualization of the patient CT data.
5}
m Surface threshold prosthesis 5} m : Slider to set the threshold for
the surface visualization of the prosthesis CT data.
6}
m
Synchronize Split view 6} m: Deactivate this checkbox to disable
7}
m 8}
m the synchronized split view. You will be able to move and rotate both
views individually.
9}
m
Add marker 7} m : Add markers to be considered during alignment.
Click alternating the CT data of the patient and prosthesis to define
pairs of markers, each pair consisting of one point on the CT dataset
and one corresponding point on the prosthesis CT data (See Figure
10.10). Hold CTRL while clicking on on a marker in one of the CT
datasets to remove that marker. You need to define at least three
pairs of markers in order to start the alignment.
datasets and lists the number of correlating markers (if you defined
at least three pairs of markers).
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Clicking Change Implant Setup in the Expert toolbar / context menu opens the Change Implant Setup window (see Figure
11.1). Note that the window consists of two expandable sections for the upper and lower jaw if you are planning implants in
both the upper and lower jaw.
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WARNING
An incorrect definition of the mandibular nerve can cause a permanent injury of the patient
during the surgical implanting procedure.
Skipping the process of defining the mandibular nerve canal might cause injury to the patient,
e.g., resulting in permanent impairment of the nerve.
HINT
Use one of the methods described in the chapters 12.2.2 and 12.2.3 to locate and define the mandibu-
lar nerve. If in doubt, increase the diameter of the mandibular canal to fully encapsulate the pa-
tient’s nerve.
Since the thickness and structure of the mandibular nerve can vary, you define a “tube” that must encapsulate the entire
nerve and possible nerve branches. Complicated cases of nerve structures might require increasing the tube size (see Chap-
ter 12.1.7) or creating multiple slopes during the channel definition to cover all areas at risk.
If you define the mandibular canal distant to the data range shown by the depth indication lines displayed during the panoramic
curve definition step (see Figure 7.2), this can cause distortion effects in the panorama view (see Chapter 7 for details on how
to create the panorama view; see Chapter 23.5 for details on the panorama view).
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5}
m 4}
m
1}
m
2}
m
6}
m
7}
m
3}
m
1}
mMain view (see Chapter 12.1.1)
2}
mSecondary view: curve cut view (see Chapter 12.1.2)
3}
mSecondary view: panorama view (see Chapter 12.1.3)
4}
mDICOM Control (see Chapter 12.1.4)
5}
mGroup Selector (see Chapter 12.1.5)
6}
mView presets (see Chapter 12.1.6)
7}
mDefine Mandibular Canal window (see Chapter 12.1.7)
Clicking in a sectional view (e.g., curve cut, panorama view in cut mode) directly sets a point for the mandibular canal.
See Chapter 12.2.1 for details.
Implant Control (see Chapter 25.2) or the view preset buttons (see Chapter 12.1.6).
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3}
m
1}
m
2}
m
4}
m
6}
m
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5}
m
7}
m
8}
m 9}
m
If your project definition requires to define only one nerve, only buttons for the corresponding jaw side will be displayed.
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Function Description
Clear 2}
m Clears any existing definition for the corresponding mandibular canal.
Lock 3}
m Lock the defined mandibular canal(s). This can be helpful when you are using other
tools during this step (e.g., the Measurement Tool, see Chapter 26.1) and want to avoid
unintended changes in your mandibular canal definition.
Canal Diameter 4}
m Define the nerve tube’s diameter. Choose a diameter covering the complete extent of
the mandibular nerve.
Undo/Redo 7}
m Undo/redo previous actions. If you define canals on both sides, these buttons
undo/redo the last action on the currently selected side.
Back / Cancel 8}
m Abort the mandibular canal definition step, close the window. All changes made since
you entered the step will be discarded.
Next / OK 9}
m Complete the mandibular canal definition step, save all your settings, and close the
window.
12.2 Step-by-Step
This chapter describes three possible methods for defining the mandibular canal:
Method A: Using the curve cut view (see Chapter 12.2.2)
Method B: Using the panorama view (see Chapter 12.2.3)
Combining method A and method B (see Chapter 12.2.4)
There are also other methods for defining the mandibular canal. However, these three common methods are the most effi-
cient ways to define the nerve properly.
To set the first point, click where you want to begin defining
the nerve channel. The point appears gray. All other views
are automatically focused to the latest point. A yellow out-
line around the point indicates the canal’s diameter.
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Each time you click or drag a point in a point sequence, all views focus this point.
Your defined mandibular canal will be visualized in all views, regardless of the sectional views you used to set your points.
Clicking a sectional view while in the mandibular canal definition step adds a new point to the currently defined mandibular
canal. You can avoid this behavior by activating Lock in the Define Mandibular Canal window (see Chapter 12.1.7). This can
be helpful if you want to use other tools, e.g., the Measurement Tool (see Chapter 26.1).
Step 1: Click the mental foramen in the main view. This will focus all views to this position.
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Step 2: Set the first point in the curve cut view. If possible, position the first point where the nerve enters the jawbone.
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Step 3: Set additional points in the curve cut view until the nerve channel continues backwards from your perspective.
When setting the point from which the channel will continue backwards, hold SHIFT. This shortcut moves the
curve cut view automatically a little further back along the panoramic curve after you set a point.
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Step 4: Continue setting points while holding SHIFT until you have sufficiently covered the region of interest for your
case. You can check the progress and result of your nerve channel definition, for instance, in the panorama view
and in the main view (see Figure 12.3).
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You can view the point sequence in the curve cut view by holding the right-mouse button and dragging the mouse left or
right. This will move the curve cut view along the panoramic curve (see Chapter 23.4. For a detailed description of view-
related functions in the curve cut view see Chapter 23.4.1).
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Step 1: Move the cut position in the panorama view by holding the right-mouse button and dragging the mouse to
visualize the mandibular canal.
Step 2: Starting from either end, place points along the course of the mandibular canal until you have sufficiently covered
the region of interest. If necessary, adjust the cut position during point placement.
In the panorama view, the depth position of points may be hard to identify. Sometimes a point appears correctly set in the
panorama view but is actually not inside the nerve channel because the depth position is off. To check if the depth position of
a point is correct, use the curve cut view as a reference and activate Show View Intersection Marker in the secondary view
visualization settings (see Chapter 23.2.3). An orange line then indicates the current position of the panorama view, allowing
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Step 1: In the curve cut view, set points as described in Method A, Steps 1 - 3. Do not hold SHIFT while setting the point
from where the nerve channel continues backwards.
Step 2: In the panorama view (cut mode), set the remaining points as described in Method B, Steps 1 - 2.
Figure 12.4: Mandibular canal defined in curve cut view and panorama view
Once you have set all points for the mandibular canal, you can leave the mandibular canal definition step and proceed in the
workflow. Note that you do not need to finalize the mandibular canal definition with a specific action like double-clicking.
If needed, you can delete previously defined mandibular canals at a later point in the workflow using the Delete Constructed
Parts option in the context menu / Expert toolbar (see Chapter 21.3).
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13 Sinus Segmentation
5}
m 6}
m
2}
m
3}
m
1}
m
7}
m 4}
m
1}
mMain view (see Chapter 12.1.1)
2}
m
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3}
mSecondary view: sagittal view (see Chapter 13.1.3)
4}
mSecondary view: coronal view (see Chapter 13.1.4)
5}
mGroup Selector (see Chapter 13.1.6)
5}
mDICOM Control (see Chapter 13.1.5)
7}
mSinus Segmentation window (see Chapter 13.2)
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WARNING
An incorrect definition of the sinus cavity can cause a permanent injury of the patient during
the surgical implanting procedure.
Skipping the process of defining the sinus cavity can cause a permanent injury of the patient
during the surgical implanting procedure.
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13.2 Step-by-Step
Step 1: Using the Threshold slider 1} m , you can adjust which intensity
values exoplan will consider as potential sinus region. In
Preview mode 2} m , the secondary view visualization switches
from solid segmentation cut mode to solid critical cut
mode, which makes the differences in density become clearly
visible. Select a threshold value that clearly separates the sinus
areas from the surrounding nasal areas (i.e.: there should be no
holes visible in the sinus area and no connection between the
sinus area and other surrounding areas). Click the Show more
button 3} mto display positive and negative examples for the
threshold value.
3}
m
Step 2: In a secondary view, click within the sinus area. We recommend
2}
m using the axial view as shown in Figure 13.3.
Step 3: You can start the segmentation with the Start Segmentation
1}
m
button 4} m . Once the segmentation is done, the segmented
4}
m area (the area which is considered as sinus region) is highlighted
in the secondary views as shown in Figure 13.4.
6}
m
Step 4: Now you can decide to either accept the segmentation by
selecting Create collision object 5}
m or to redo it.
5}
m
Clicking undo segmentation 6} m will only undo the last segmention
7}
m and all created collision objects will remain. Clicking Delete all Si-
nus Meshes 7} mwill delete all created collision objects and the Si-
nus Segmentation step will restart from the beginning.
Similar to the mandibular nerve canals, the sinus area meshes are now collision objects that prevent the user from placing
an implant or anchor pin too close to the collision object mesh.
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Figure 13.3: Sinus Segmentation: Setting the seed point in Figure 13.4: Sinus Segmentation: Highlighted sinus cavity
axial view after successful segmentation
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HINT
After exoplan segmented the sinus cavity, make use of the provided secondary views to check if you
are satisfied with the segmentation. See Chapter 23.2 for details. If you are not satisfied with the
segmented sinus cavity, use the tools described in Chapter 13.3 to manually edit the segmented
volume.
1}
m 2}
m
After creating a collision object, you can edit the mesh using free-forming and cropping functions. The Free-forming section
1}
mprovides the same functions as described in Chapter 21.5.1. The Cropping section 2} mprovides the same functions as
described in Chapter 21.5.2. When free-forming a collision object, you can switch to the secondary view Axial if you prefer to
perform the free-forming in 2D. An orange sphere indicates the position of the free-forming tool in all active views.
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3}
m 2}
m
1}
m
4}
m
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1}
mMain view (see Chapter 14.1.1)
2}
mDICOM Control (see Chapter 14.1.2)
3}
mGroup Selector (see Chapter 14.1.3)
4}
mPlace Model Teeth window (see Chapter 14.1.4)
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Function Description
Mesial Contact of Tooth Define the mesial contact point for the tooth/teeth in the bridge.
Distal Contact of Tooth Define the distal contact point for the tooth/teeth in the bridge.
Position on Gingiva for Define a position on the gingiva for the tooth/teeth in the bridge.
Tooth
OK Complete the initial placement step, save all your settings, and close the window.
Cancel Abort the initial placement step, close the window. All changes made since you entered
the step will be discarded.
If you are placing a bridge including the front teeth, the first two buttons will both be called Distal Contact of Tooth.
14.2 Step-by-Step
This chapter provides instructions for the following scenarios:
1. Placing a bridge for a single tooth with two adjacents: Chapter 14.2.1
2. Placing a bridge for a single tooth with one adjacent (usually last molars on distal side): Chapter 14.2.2
3. Placing a bridge consisting of multiple teeth: Chapter 14.2.3
Figure 14.3: Single tooth model with mesial and distal contact
After setting both contact points, you can still modify their positions. This will be explained in Chapter 14.2.4.
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Figure 14.4: Single tooth model with mesial contact and gingiva position
After setting both contact points, you can still modify their positions. This will be explained in Chapter 14.2.4.
For tooth numbers 7, exoplan automatically activates the gingiva position button in the Place Model Teeth window after
the mesial contact point has been defined, even if this tooth is not the last molar on the distal side. If your project includes
tooth 8, select the button for placing the distal contact manually.
(a)
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(b)
Once you have defined the first contact, you can set the next contact position only in a limited area around the first
point to prevent overscaling of the bridge.
You cannot place two contacts too close to each other. A minimum space will be kept to avoid underscaling of the
bridge.
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To skip the initial tooth placement for a bridge in Wizard mode, click Next without placing any tooth models. A dialog will
ask you to confirm that you want to skip the tooth model placement for this bridge. You may skip each bridge individually
(Skip) or choose to skip the current and all subsequent bridges. (Skip All)
Tooth libraries can be found in the Choose Library section of the Place Model Teeth window (see Figure 14.6).
To select a tooth library:
Select a library from the dropdown list, or
Use the arrow buttons to select the next/previous library in the list, or
Hold CTRL and scroll the mouse wheel to switch libraries.
After you have selected a library, the tooth models will be directly used in the main view during the current placement. You
do not have to start the placement again from scratch.
Libraries are deactivated for selection if they do not contain one or more tooth models required for the bridge or if they are
locked. See Chapter 27.4.4 for details on available tooth libraries.
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2}
m
1}
m
3}
m
4}
m
1}
mMain view (see Chapter 15.1.1)
2}
mDICOM Control (see Chapter 15.1.2)
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3}
mSecondary views ( see Chapter 15.1.3)
4}
mCorrect Model Tooth Placement window (see Chapter 15.1.4)
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(a) Simple tab (b) Advanced tab (c) Chain Mode tab
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Function Description
Move all Simultaneously Active when at least two tooth models are present. Move/rotate/scale all tooth models
simultaneously.
OK Complete the precise placement step, save all your settings, and close the window.
Cancel Abort the precise placement step, close the window. All changes made since you
entered the step will be discarded.
See Chapter 15.2 for precise tooth model placement using the Simple mode.
See Chapter 15.3 for precise tooth model placement using the Advanced mode.
Function Description
OK Complete the precise placement step, save all your settings, and close the window.
Cancel Abort the precise placement step, close the window. All changes made since you
entered the step will be discarded.
See Chapter 15.4 for precise tooth model placement using the chain mode.
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SHORTCUTS
Hold CTRL: Rotate a tooth
Hold SHIFT: Scale a tooth
Hold CTRL + SHIFT: Perform direction-based scaling
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1}
m 2}
m 3}
m Free axis selection scaling 2} madds a visualization boundary
which makes it easier to see the direction of the scaling. Hold SHIFT
to scale in one direction. Hold CTRL + SHIFT to scale in two direc-
6}
m tions.
4}
m 5}
m
The instant morphing free-form tool 3}mallows you to make basic
shape changes during the tooth setup stage (e.g., moving a cusp).
7}
m Instant anatomic morphing cutting with antagonist 4} m : If you
click and move/scale a tooth, the intersections with the antagonist
will be cut. You can only activate this option if an antagonist (i.e., jaw
scan of the opposing jaw) is present in the scene.
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2}
m
1}
m
3}
m
The tube 1}
mindicates the tooth chain. Placement discs 2}
mmark the ends of the tooth chain.
By clicking the control points 3}
m, which are present for every tooth model and the placement disc, you can pin positions of
teeth and placement discs. When pinned, the control point appears in red, and the tooth / placement disc will not be affected
by movement/rotation/scaling actions. Clicking a red control point will unpin the tooth / placement disc again.
There are three chain modes, represented by the three top buttons in the Chain Mode tab:
To move the tooth chain, click a tooth model in the chain and drag.
To rotate the tooth chain, click a tooth model in the chain where you want to apply rotation. Drag in the desired rotation
direction while holding CTRL. The greater the distance to the point you selected, the lesser the rotation influence.
To scale the tooth chain, click a tooth model in the chain and drag in the desired scaling direction while holding SHIFT.
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You can also move, rotate, and scale placement discs. When you click a placement disc, both discs will be fixed in their
positions. This allows you to move one end of the chain while the other end remains fix. Once you let the disc off, both
placement discs will be unpinned again.
The following checkboxes are available in chain mode:
Function Description
Teeth Scalable If a chain transformation is too big, the teeth will be scaled. Uncheck to deactivate.
Keep in Contact By default, the teeth remain in contact. Uncheck to deactivate. This will allow gaps and
intersections between teeth. When activated again, contacts will be re-established.
Show Chain Controls Uncheck to hide the tube and the control points.
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Move the teeth along this arch by dragging your mouse. Rotation and scaling behavior are the same as in Chain mode (see
Chapter 15.4.1).
The checkbox Keep in contact is not available, as the teeth always stay in contact. Available checkboxes are Teeth Scalable,
Show Chain Controls and Limit Rotation to Buccal/Lingual Tilt, with the same functions as in Chain and Single mode
(see Chapter 15.4.1).
In the Options section of the Chain Mode tab, the Symmetry but-
ton is activated if you place tooth models on both jaw sides at op-
posing positions. You can use the symmetry function to create a
symmetry for the right and left jaw side.
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Define a symmetry by clicking one of the four buttons. The entire Symmetry button will appear activated. Any movement/rotation/
scaling action on one jaw side will be mirrored to the other side along the symmetry plane.
To deactivate the symmetry function, click Symmetry again.
The symmetry plane control is a sphere with two arrows (see Figure 15.12). The arrows indicate which teeth are used as
exoplan.3.1_User_Manual_en, 2023–07–04
reference for the plane orientation. The reference teeth are locked (red control points).
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To change the reference teeth, click the control point of a tooth on either jaw side. The symmetry plane control will jump to
the new position and the control points of both reference teeth will appear red (see Figure 15.12).
To pin the symmetry plane, click the sphere between the arrows.
Function Description
Reset (keep red) Restores the original position of unpinned teeth (green control points), but keeps the
current position of pinned teeth (red control points).
Reset Keeps changes made in the Simple tab, discards all other changes.
Global Reset Restores the original position of all teeth, discards all changes.
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16 Implant Positioning
WARNING
exoplan does not verify if you have placed an implant at an eligible position for the selected
tooth number.
When selecting an implant for a particular tooth location make sure that the intended use/the
indications of the implant allows the usage for the respective tooth and purpose.
HINT
Use the secondary views Implant cross and Implant axial to verify the eligibility of the implant
position: Click the right mouse button and drag to analyze the surroundings of the placed implant.
Ensure that implant type, implant diameter, and implant length are chosen correctly according to
the patient’s clinical situation. In the maxillae region, ensure that no critical anatomical structures
(e.g., the floor of the maxillary sinus, the piriform foramen, and the anterior palatine nerve) will
be injured. (See chapter 16.4 for more information on placing an implant. See chapter 23.6 for a
detailed description of the implant-based secondary views.)
Refining the implant position by moving and/or rotating the implant (see Chapter 16.4)
Selecting and positioning surgical components. Surgical components include drilling sleeves, surgical kits, and proto-
cols for guided surgery. (see Chapter 16.6)
Note: Surgical kits include drills, handles, and other tools for guided surgery. Hereafter, the composition of a surgical
kit is no longer mentioned in detail. exoplan uses the term sleeve instead of drilling sleeve in the user interface.
Selecting and positioning anchor pins. This serves to design a stable surgical guide for edentulous patients and partially
edentulous patients for use in guided surgery (See Chapter 16.8).
You can freely choose the order in which you select and place implants, surgical components, prosthetic components and
anchor pins.
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6}
m 5}
m
2}
m
1}
m
3}
m
7}
m 4}
m
1}
mMain view (see Chapter 16.1.1)
2}
mPanorama view (see Chapter 16.1.2)
3}
mCurve cut view (see Chapter 16.1.3)
4}
mCurve tangent view (see Chapter 16.1.4)
5}
mDICOM Control (see Chapter 16.1.5)
6}
mGroup Selector (see Chapter 16.1.6)
7}
mImplant Positioning window (see Chapter 16.1.7)
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8}
m 5}
m
7}
m
4}
m
2}
m
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Align: functions for moving and rotating the implant and all attached parts (see Chapter 16.4).
3}
mSettings: implant settings (see Chapter 16.5).
4}
m: The left side of the window lists all tooth numbers for which an implant is planned. Show/hide tooth entries for the
6}
m: Using the search field at the top of the window, you can find implant manufacturer libraries and individual implants.
7}
m: All implant types of a selected manufacturer are shown on the right. Subtype, length, and diameter become available
for selection when you have chosen an implant type.
8}
m : Add further implants and remove planned implants (see Chapter 16.5.1). Add anchor pins (see Chapter 16.8).
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3}
m
1}
m
Step 1: Choose the tooth number of the implant you want to position and click Select implant 1}
m.
Step 2: Select a manufacturer using the search field at the top of the window 2} m . You can combine your search with
available filters. Alternatively, use the bottom scroll bar to browse through the list of manufacturers.
If you position multiple implants, an implant part library based on the already positioned implant models will be
preselected in the library list.
If you already selected a sleeve or prosthetic component, only compatible implants are displayed.
Step 3: Select an implant type from the selected manufacturer’s library 3m
}.
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8}
m
4}
m
5}
m
9}
m
6}
m
7}
m
Step 4: Select the implant’s length and diameter using the table 4}
m below the implant library selection menu. The colors
shown in the table indicate the implant’s diameter. The color selection and the availability of colors depend on
the manufacturer.
Step 5: The preview section 5} mshows a 3D preview of the selected implant. Hold the right mouse button and drag to
rotate the preview. Scroll the mouse wheel to zoom the preview.
Detailed information about the selected implant is displayed in an information box next to the implant preview.
The displayed information depends on the implant library settings defined by the manufacturer / library provider.
Step 6: Click Confirm 6}m to complete the implant selection step and position the selected implant using the functions
described in chapter 16.3, or proceed with the selection of sleeves/kits (see Chapter 16.6) and/or prosthetic
components (see Chapter 16.2.1) 7} m / 8}
m.
If you are planning multiple implants, select the tooth number for the next implant from the menu on the left 9m
}to choose
and position the desired implant.
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HINT
Click the star symbol next to a library entry to define this library as a favorite. Favorites can be
accessed using the button Favorites 1} m and will persist when you restart exoplan.
If your desired implant part is not available for selection in this step, launch the exocad Library
Manager by clicking the Download more... link at the top of the Implant Positioning window 2} m .
Follow the instructions in the Library Manager to download your desired implant library. Restart
exoplan afterwards.
1}
m
2}
m
The Library Manager can only install libraries that are approved for the regulated market for which
exoplan was developed.
WARNING
Ensure that the correct implant type including platform type / platform length and diameter is
selected according to the clinical situation of the patient. Pay particular attention to this when
planning an implant case near a major anatomical feature such as arteries or alveolar nerve.
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NOTE
You cannot complete the implant positioning step if there is a collision between invasive parts (i.e.,
implants, anchor pins), or between invasive parts and a mandibular nerve. Resolve collisions by
repositioning implants or by changing the safety distance around implants (see Chapter 16.5.3). If
exoplan detects a collision between an invasive part and a created sinus cavity collision object, you
can decide to continue in the workflow at your own risk.
See Chapter 27.5 for details on collisions.
SHORTCUTS
While the mouse cursor is above an implant preview or a positioned implant:
Hold CTRL and scroll the mouse wheel to change the implant length.
Hold SHIFT and scroll the mouse wheel to change the implant diameter.
You can remove an implant by clicking the recycle bin icon that appears when hovering over the implant entry in the
Select tab.
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When placing an implant too close to a collision object, the selected implant’s color changes from yellow to orange,
the affected collision object will be colored in red.
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1}
m 2}
m
To move/rotate an implant, select the corresponding tooth number in the Implant Positioning window or double-click the
implant in a view. All attached parts will be moved/rotated together with the selected implant.
To move the implant, select Move Implant 1} m , click the implant and drag it to the desired position. You can select to
move the implant freely, along the implant axis or in the implant’s axial plane.
To rotate the implant, select Rotate Implant 2}m , click the implant and drag it in the desired rotation direction. You
can select to move the implant around its center, around the implant axis, or around the top/bottom of the implant.
SHORTCUT
Hold CTRL in Move Implant mode: Rotate the implant according to the rotation option currently
selected in Rotate Implant mode.
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In addition to using the move/rotate function, you can use the widgets that
are displayed in the main view to rotate the implant around the implant
axis 1}mor around a pivot point which is positioned above the bone level
2}
m . You can also use widgets to adjust the length 3}
m and diameter 4} m
2}
m of
the implant: Double-click an orange sphere adjacent to the green sphere
or drag the arrow in the desired direction. All movement/rotation actions
are displayed simultaneously in all views, regardless in which view you ap-
plied them. In certain views, some rotation and movement actions are re-
stricted or not possible.
1}
m If your project contains a multi-unit abutment with an angled superstruc-
ture relative to the implant, you can rotate the implant around the pros-
thetic axis by right-clicking an implant with angled superstructure and se-
lecting Keep prosthetic axis in place - rotate implant, or rotate the pros-
4}
m
thetic individually by selecting Keep implant in place - rotate prosthetic
(see Figure 16.9).
3}
m
Figure 16.8: Widgets in main view Figure 16.9: Options to rotate superstructure
Click Undo/Redo to undo/redo movement/rotation actions. These functions only apply to the currently selected implant.
You cannot undo/redo implant part changes performed in the Select tab (see Chapter 16.2).
If you position multiple implants, choose Show/Hide Inactives to show/hide currently not selected implants in all views.
WARNING
During implant positioning, ensure the feasibility of the surgery for the particular implant position.
Consider the existing dentition and study the insertion channels for the respective implant.
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HINT
Before you proceed, make sure that with your choice of implant position no structures at risk will
be damaged. You must visually inspect the vicinity of the chosen implant position.
In the secondary view parallel to the implant axis (Implant cross view): Press and hold the
right mouse button and move the mouse left or right to rotate the view around the implant
axis. Visually inspect the surrounding anatomical structures while rotating the view.
In the secondary view perpendicular to the implant axis (Implant axial view): Press and hold
the right mouse button and move the mouse up and down to move the view along the implant
axis. Visually inspect the surrounding anatomical structure while moving the view.
During the visual inspection you can use the visualization of the insertion channel (pink) and
the visual representation of the minimum safety distance around the implant to visually as-
sess the distances to anatomical structures.
To parallelize two implants, right-click on a selected positioned implant during the Implant Positioning step to open
the context menu. Select Align this implant’s direction to and choose the implant you want to parallelize the cur-
rently selected implant to (See Figure 16.10).
To parallelize the direction of the prosthetic parts of two implants, right-click on a selected positioned implant dur-
ing the Implant Positioning step to open the context menu. Select Align this implant construction’s prosthetic
direction to and choose the implant’s prosthetic direction you want to parallelize the currently selected implant’s
prosthetic direction to. This is helpful when working with angulated prosthetic components (e.g., angulated stock abut-
ments).
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1}
m
Changes in the implant positioning settings affect all implants (not only
the currently selected implant).
2}
m
In the Settings tab of the Implant Positioning window, you can
Using the functions in this window, you can change the implant setup, de-
fine additional implants, and delete implants. See Chapter 11 for detailed
instructions on how to change the implant setup.
If you have already positioned implants for the affected teeth, a dialog in-
forms you that the implant and all its parts will be deleted if you change
the implant setup. Click OK to confirm.
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In Expert mode, you can edit the implant setup at any point using the
Change Implant Setup option (Chapter 11).
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Visualization Modes:
Standard: Sets the implant visualization to the manufacturer’s predefined color.
Natural Texturing: Sets the implant visualization to solid (natural) color scheme (see Chapter 5.2.4).
Threshold Visualization: Sets the implant visualization to blue/red according to density threshold definition (only
available if you have defined a density threshold value).
WARNING
A safety distance below 1.5 mm should only be used in exceptional cases with particular care.
Consider increasing the safety distance for the collision detection to compensate for the de-
creased precision of the surgical guide when working with edentulous patients in the dual
scan workflow.
The safety distance indicator appears red if there is a collision. When checking for collisions between two implants, the safety
distance is doubled. For example, if you have defined a safety distance of 2.0 mm around implants, a collision will be detected
if the distance between two implants is below 4.0 mm (safety zones overlap).
See Chapter 27.5 for details on collisions.
exoplan.3.1_User_Manual_en, 2023–07–04
Figure 16.13: Implant with safety distance and bone level visualization
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2}
m
3}
m
1}
m
Step 1: Choose the tooth number of the sleeve you want to position and click Select surgical component 1}
m.
Step 2: Select a manufacturer using the search field at the top of the window 2} m . You can combine your search with
available filters. Alternatively, use the bottom scroll bar to browse through the list of manufacturers.
If you position multiple implants, a sleeve/kit library based on the already positioned implant models will be
preselected in the library list.
Step 3: Select a surgical component system from the selected manufacturer’s library 3}
m. Only libraries compatible with
the selected implant are now available for selection.
9}
m
8}
m 4}
m
5}
m
6}
m
7}
m
Step 4: Select the sleeve type / kit / protocol using the table 4}
mbelow the library selection menu.
Step 5: The preview section 5} mshows a 3D preview of the selected surgical component. Hold the right mouse button
and drag to rotate the preview. Scroll the mouse wheel to zoom the preview.
Detailed information about the selected sleeve / kit / protocol is displayed in an information box next to the
implant preview. The displayed information depends on the library settings defined by the manufacturer / library
provider.
Step 6: Click Confirm 6} mto complete the selection step. exoplan positions the selected sleeve. You can adjust the
sleeve’s position as described in Chapter 16.7.
If the corresponding implant has not been positioned yet, you can position the selected implant and sleeve
together using the functions described in chapter 16.3, or proceed with the selection of an implant (see Chapter
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HINT
If your desired drilling sleeve library is not available for selection in this step, launch the exocad
Library Manager by clicking the Download more... link at the top of the Implant Positioning win-
dow 9} m . Follow the instructions in the Library Manager to download your desired sleeve library.
Restart exoplan afterwards.
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WARNING
When you have selected a freely positionable drilling sleeve, exoplan does not automatically
select a compatible surgical kit and respective tools. This responsibility fully remains with
the user.
The displayed drill depth is approximated from the geometric mesh provided by the manu-
facturer of the respective implant.
The distance of the sleeve shoulder to the implant’s apical peak is calculated based on the
implant mesh provided by the implant manufacturer. In case this mesh does not perfectly
represent the real physical implant geometry, there will be a deviation.
NOTE
The accuracy of drilling sleeve placement for fixed predefined positions is 0.01mm measured
from the drilling sleeve’s upper part to the implant’s apical point and the implant’s reference
point (the insertion point of the prosthetic device).
For drilling sleeves without predefined fixed height values, the accuracy of displaying the drilling
sleeve’s distance to the virtual implant’s apical point is 0.01mm.
The usage of a generic sleeve in a drill guide requires verification of the real drill depth during
the intervention.
Sleeves are necessary for the creation of a surgical guide. If you skip the sleeve positioning
you must place sleeves in the surgical guide workflow.
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1}
m
Step 1: In the Select tab of the Implant Positioning window, you can add an anchor pin for the upper/lower jaw by
clicking the corresponding button 1}
m . A new entry is added to the list in the Select tab and exoplan opens the
anchor pin selection menu.
2}
m
7}
m
3}
m
4}
m
5}
m
6}
m
Step 2: Select an anchor pin library using the search field at the top of the window 2}
m. Alternatively, use the scroll bar to
browse through the list of manufacturers.
Step 3: Select an anchor pin from the selected manufacturer’s library 3}
m.
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to the anchor pin in the main view. Alternatively, hold CTRL while clicking and dragging the anchor pin, or use
the blue rotation handles in the secondary views Implant cross and Implant axial. Use the gray arrow widget to
adjust the anchor pin’s position along the insertion axis. To adjust the length of the anchor pin, double-click an
orange sphere adjacent to the green sphere or drag the gray arrow in the desired direction.
Step 8: Repeat steps 1-7 to place another anchor pin.
You can remove an anchor pin by clicking the recycle bin icon that appears when hovering over the anchor pin entry in
the Select tab.
When placing an anchor pin too close to a collision object, the selected anchor pin’s color changes from yellow to or-
ange, the affected collision object will be colored in red.
When several anchor pins have been placed, you can select an anchor pin from the list in the Select tab of the Implant
Positioning window or by double-clicking it in the Main View or in any of the secondary views.
A potentially existing sleeve for an anchor pin will be displayed automatically.
HINT
If your desired anchor pin is not available for selection in this step, launch the exocad Library Man-
ager by clicking the Download more... link at the top of the Implant Positioning window 7} m . Fol-
low the instructions in the Library Manager to download your desired anchor pin library. Restart
exoplan afterwards.
WARNING
The implant planning report shows information regarding which anchor pins are used/placed
but neither the implant planning report nor the surgical report will detail information about
the drill (length/diameter) to use.
When a library with anchor pins is updated, the parts of the previous version of the updated
library in saved scenes are not updated automatically. To update them in the scene, the im-
plant positioning step must start again with subsequent confirming to update the libraries.
HINT
Carefully read the instructions of the anchor pin manufacturer and check which drill to use for the
exoplan.3.1_User_Manual_en, 2023–07–04
specific anchor pin. If in doubt, contact the anchor pin manufacturer or your reseller.
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HINT
Anchor pins can only be placed in the implant planning workflow but not in the surgical guide work-
flow. If you are working on an edentulous case and do not place any anchor pins in this Wizard step,
exoplan prompts you to decide upon clicking Next whether you really want to skip the anchor pin
placement or return to the Implant positioning step to place anchor pins.
If you choose not to place anchor pins for an edentulous case, you will not be able to create a fixa-
tion guide.
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17.1 Step-by-Step
To generate implant planning result files, you must first approve the planning result in the Approval of Planning dialog (see
Figure 17.2).
Patient information section: patient information specified in the CT data and in the project file, for ensuring you are
using the correct CT data for the patient. For edentulous cases (Dual Scan Protocol), an additional column shows the
information specified in the CT data of the prosthesis for ensuring you are using the correct prosthesis CT data. Note
that the approval dialog contains DICOM dataset information of up three datasets (patient, lower prosthesis, upper
prosthesis) if you are planning implants for edentulous patients in both jaws.
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Approval content section: planning approval statements you confirm by approving the implant planning result.
If the loaded DICOM dataset contains accepted issues as described in chapter 1.11.1, you need to confirm that you are
aware of the issue(s) in the loaded DICOM dataset(s).
Read the statements in the dialog carefully and confirm only if you agree with all listed items.
To generate the implant planning result files, click the approval checkbox to confirm you have read the statements and will
handle the planning result files carefully. This activates the button I agree. Click I agree to confirm your planning result and
to initiate the planning result files generation process.
Alternatively, click Cancel to close the Approval of Planning dialog. You can check the planning result in the views and
modify the result, if necessary. To initiate the planning result files generation, click Generate Output in the Generate Im-
plant Planning Result Files dialog (see Figure 17.3).
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You can save the scene without approving the implant planning using the button Save scene.
Figure 17.3: Generate Implant Planning Result Files window in Expert mode
Generating the implant planning result files can take some time. The duration of this process depends on the size of loaded
meshes and the number of implants. When the process is complete, the Generate Implant Planning Result Files window
is updated (see Figure 17.4).
Figure 17.4: Generate Implant Planning Result Files window after completed files generation process (Expert mode)
Function Description
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Open Project Directory Open the project directory where exoplan saves the planning result files.
OK Close the Generate Planning Result Files dialog, keep the planning result files.
Cancel Close the Generate Implant Planning Result Files dialog. exoplan prompts
you to decide if you want to delete the previously generated implant planning
result files from the project directory.
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After the generation of the implant planning result files, exoplan displays a button in the main toolbar
which indicates that the planning has been approved. You can click the button to view detailed informa-
tion.
If you change implant positions or settings in exoplan and save the result, existing planning result files will not be updated.
If you change your implant planning result (e.g., by removing tooth models, deleting the mandibular canal, remove/add im-
plants), existing planning result files for the current project and jaw will be deleted in the project directory, and you must
regenerate them. All files with implantplan in the filename will also be deleted, even if they are not planning result files.
The project directory only contains the last generated set of implant planning result files (or no implant planning result files,
if they were deleted).
See Chapter 27.7 for more information.
Figure 17.5: Generate Implant Planning Result Files window during files generation
Click Abort Writing to abort the files generation process. Implant planning result files already generated during this process
will be deleted.
Clicking Cancel in the Generate Implant Planning Result Files window during files generation also aborts the process
but closes the Generate Implant Planning Result Files window after prompting you to delete already generated planning
result files.
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17.3 Generating Provisional Implant Planning Result Files for Individual Implants
In Expert mode, you can generate provisional implant planning result files for individual implants, even if you have not yet
positioned all implants:
Step 1: In Expert mode, click one of the positioned implants in the main view while no workflow step is open. To select
multiple implants, hold CTRL while clicking the desired implants.
Step 2: Select Generate Implant Planning Result Files in the Expert toolbar. This opens the Approval of Planning
dialog (see Figure 17.2).
Step 3: Approve your planning result. exoplan will generate implant planning result files for all positioned implants. The
implant planning result files will be marked as provisional, indicating that not all implants are considered.
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17.5 Selecting the Workflow After Generating Implant Planning Result Files
1}
m
2}
m
3}
m
4}
m
5}
m
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You can create surgical guides with exoplan if the Surgical Guide add-on module is activated on your exoplan dongle. For
information regarding add-on modules and purchase/installation, please contact your exoplan reseller.
This chapter describes how to create a surgical guide using the Wizard workflow. You can select the worksteps individually
using the Expert mode. See Chapter 20 for details on the Wizard/Expert mode.
WARNING
Please note that manufactured surgical guides for endosseous dental implant placement are clas-
sified as medical devices by the FDA, regulated under 21 CFR 872.3980. As such, they are subject to
legal requirements such as registration and listing as a manufacturer of medical devices, validation
of production equipment/processes and quality system regulations.
WARNING
Verify the surgical guide manufacturing process and the surgical guide before using it for the
treatment of patients.
When the surgical guide bridges over multiple missing teeth, make sure that the solid fit of the
surgical guide is still ensured and that it does not bend or is not tilted under load. In particular,
this applies for multiple missing canine and incisors.
When designing a surgical guide for edentulous cases or partially edentulous cases, use an-
chor pins to guarantee a stable fit of the surgical guide.
Make sure that the design of the surgical guide does not contain sharp edges, ridges, or peaks
to avoid injuries of the patient’s soft tissue such as the tongue.
HINT
Produce surgical guides for testing and ensure that they fit firmly on a corresponding model
and that the implants are placed in the correct position. Ensure that no relevant deviations
exist.
If the surgical guide is created by a dental lab, both parties (i.e., dentist and lab) must clearly
exoplan.3.1_User_Manual_en, 2023–07–04
communicate and agree on which implants, sleeves, surgical kit, anchor pins and additional
requirements for particular design properties to use (collaborating parties/partners may use
the project notes to exchange notes).
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Select Base Mesh For Select or load the base mesh(es) for the surgical guide (see Chapter 18.3).
Guide Design
Design Sleeve Mounts Design the mounts for the planned drilling sleeves and the define the settings for placed
anchor pins (see Chapter 18.5).
Design Surgical Guide Design the bottom of the surgical guide by blocking out undercuts, setting the insertion
Bottom direction, and using free-forming tools (see Chapter 18.6).
Designing the Surgical Define the shape of the surgical guide’s top (see Chapter 18.7).
Guide Top
Adding Attachments Stabilize the surgical guide with supports, add inspection windows and text attachments to
the surgical guide (see Chapter 18.8).
Merging the Surgical exoplan automatically merges and saves the designed surgical guide into one single mesh
Guide (see Chapter 18.9).
Free-Forming the Use free-forming tools to adjust the shape of the merged surgical guide (see Chapter 18.10).
Merged Surgical Guide
Generating the exoplan automatically generates the surgical guide result files (see Chapter 18.14).
Surgical Guide Result
Files
Select Base Mesh For Select or load the base mesh(es) for the surgical guide (see Chapter 18.3).
Guide Design
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Defining the Gingiva This Wizard step only appears if you define the base mesh as prosthesis in the step Select
Contact Surface Base Mesh For Guide Design (see Chapter 18.4).
Design Sleeve Mounts Design the mounts for the planned drilling sleeves and the define the settings for placed
anchor pins (see Chapter 18.5).
Design Surgical Guide Design the bottom of the surgical guide by blocking out undercuts, setting the insertion
Bottom direction, and using free-forming tools (see Chapter 18.6). This step only appears if you
choose the option Design guide in the step Define Gingiva Contact Surface.
Designing the Surgical Define the shape of the surgical guide’s top (see Chapter 18.7). This step only appears if you
Guide Top choose the option Design guide in the step Define Gingiva Contact Surface.
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Adding Attachments Stabilize the surgical guide with supports, add inspection windows and text attachments to
the surgical guide (see Chapter 18.8).
Merging the Surgical exoplan automatically merges and saves the designed surgical guide into one single mesh
Guide (see Chapter 18.9).
Free-Forming the Use free-forming tools to adjust the shape of the merged surgical guide (see Chapter 18.10).
Merged Surgical Guide
Creating a Fixation Design a separate fixation guide to be used in guided surgery (see Chapter 18.11).
Guide
Merging the Fixation exoplan automatically merges and saves the designed fixation guide and its attachments
Guide into one single mesh (see Chapter 18.12).
Free-Forming the Use free-forming tools to adjust the shape of the merged fixation guide (see Chapter 18.13).
Merged Fixation Guide
Generating the exoplan automatically generates the surgical guide result files (see Chapter 18.14).
Surgical Guide Result
Files
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Load from file 1} m : Load a file to be used as base mesh. If you load
a base mesh in this step, it will be loaded as an optical scan and set
as the currently selected base mesh for the jaw. exoplan displays all
2}
m loaded meshes in a dropdown list.
1}
m
You can delete the selected base mesh from the scene by clicking the
3}
m recycle bin icon next to the dropdown list 2} m . Note that deleting a
base mesh is not possible if it was used for the CT alignment.
4}
m
Scan represents a prosthesis 3} m : Activate this checkbox to spec-
ify that the gingiva contact surface of the currently selected base
mesh should be extracted later. The step Define Gingiva Contact
Surface (see Chapter 18.4) then appears for the corresponding jaw
after this step. This checkbox is activated by default for a prosthesis
mesh as base mesh and cannot be unchecked in this case.
If you select or load a base mesh that does not match the CT align-
ment object, a warning message is displayed at the bottom of the
window. It prompts you to check the alignment between both
meshes. Open the Align meshes tool 4} mto align the loaded mesh
with the CT alignment object of the affected jaw if required. See
Chapter 26.5 for detailed information on the Align Meshes tool.
defined the selected surgical guide base mesh as prosthesis (see Chapter 18.3), you need to mark an area on the prosthesis
mesh that will be used as the contact surface to the gingiva. Note that this step appears twice in the workflow if you are
planning implants in both the upper and lower jaw.
You can define the contact surface by painting an area on the mesh using a brush tool 1}
m(see Chapter 18.4.1) or by marking
the boundaries of the contact surface with a spline tool 2}
m (see Chapter 18.4.2).
Note that you cannot continue the workflow without generating a gingiva contact surface from an area of the prosthesis
mesh.
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Mark an area on the prosthesis mesh using the brush tool (see Figure 18.3).
This area will be used as the contact surface to the gingiva.
7}
m You can adjust the size of the brush using the Brush Size 3}
mslider
or by holding SHIFT while scrolling up or down.
1}
m 2}
m
You can delete parts of the painted area by holding SHIFT while us-
ing the brush tool.
3}
m
Apply the marking by clicking Generate contact surface 4}
m. This
5}
m
will extract the marked area from the prosthesis mesh.
4}
m
You can delete the generated marking by clicking the Clear mark-
ing & mesh 5}m button.
Click the button Show More 7} m to see positive and negative examples of
6}
m the contact surface definition using the brush tool.
Choose whether you want to design the surgical guide freely (i.e., by defin-
ing the bottom and top part), or use the prosthesis mesh as the surgical
guide base by selecting the corresponding option 6} m (see Figure 18.6). In
case you do not select any of the options and want to proceed to the next
step, exoplan will prompt you to do so.
If you want to set a default surgical guide design option, select the corre-
sponding option in the exoplan settings (see Chapter 26.7).
Figure 18.3: Brush tool: Positive and negative example of the gingiva contact surface definition
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Define a curve along the outer ridge of the prosthesis mesh by placing con-
trol points using the left mouse button (see Figure 18.5). To delete a control
point, right-click it while holding it with the left mouse button. Make sure
the area you define includes the possible contact surface to the gingiva.
4}
m
Avoid free floating connection lines (indicated in red), e.g., by placing
more control points in the vicinity of the red lines.
1}
m You can delete the generated marking by clicking the Clear curve
& mesh 2}m button.
Click the button Show More 4} m to see positive and negative examples of
the contact surface definition using the spline tool.
3}
m Choose whether you want to design the surgical guide freely (i.e., by defin-
ing the bottom and top part) or use the prosthesis mesh as the surgical
guide base by selecting the corresponding option 3} m (see Figure 18.6). In
case you do not select any of the options and want to proceed to the next
step, exoplan will prompt you to do so.
If you want to set a default surgical guide design option, select the corre-
sponding option in the exoplan settings (see Chapter 26.7).
Figure 18.5: Spline tool: Positive and negative example of the gingiva contact surface definition
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HINT
It is advisable to edit the mesh before defining the gingiva contact surface.
Use the tools in the tab Mesh Editing to remove mesh artifacts from the prosthesis mesh. Espe-
cially, remove floating or connecting mesh artifacts within the prosthesis mesh by using the 3D
Surface Editor tool. This is described in detail in Chapter 18.9.1.
Additional Rounding 2}
m: Set the radius for smoothing the
mount’s edges.
Height 3}
m: Set the mount’s height.
1}
m
Clearance above 4} m: Set an area above the mount which will re-
main clear for the drilling tool(s). If parts of your surgical guide de-
2}
m
sign enter this area, they will be removed during finalization. By de-
fault, this area is locked to the sleeve mount’s diameter. To unlock
3}
m the slider, click the lock icon.
4}
m Clearance Height 5}
m: Slider to set the sleeve mount’s clearance
height.
5}
m Rotation Marker Count 6} m: Single displays a single rotation
marker on the sleeve mount. Multiple displays multiple equally
6}
m distributed rotation markers on the sleeve mount. All displays all
rotation markers.
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WARNING
The Minimum Base Thickness of a sleeve mount/anchor pin mount is a crucial parameter for
the stability of a surgical guide. If the value is too low, the surgical guide may bend or break
under load. Please regard that a suitable value for the minimum thickness is dependent on
the material intended for surgical guide manufacturing.
Hint: Check the minimum requirements specified by the material manufacturer and ask your
reseller if you are in doubt.
Use the Clearance Above function with care and choose a value appropriate for the selected
tools for surgery.
The Radial sleeve offset value is dependent on the material/printer combination used for
surgical guide manufacturing and requires experience with used material and equipment.
Wrong settings result in ill-fitting sleeves in the surgical guide.
NOTE
The accuracy of the radial sleeve offset is 0.01mm. This means that the virtual gap of the drilling
sleeve to the surgical guide may deviate by 0.01mm.
HINT
Check the recommendations of the printer and the material manufacturers and ask your reseller
for further recommendations.
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1}
m
If your project contains any placed anchor pins, you can design the anchor
2}
m pin mounts using the following sliders:
3}
m Minimum Base Thickness 1} m : Set the mount’s minimum thickness
(radius), measured to the beginning of the smoothed edge area.
4}
m
Additional Rounding 2}
m: Set the radius for smoothing the
mount’s edges.
5}
m
Clearance above 3} m : Set an area above the mount which will re-
main clear for the drilling tool(s). If parts of your surgical guide de-
sign enter this area, they will be removed during finalization. By de-
fault, this area is locked to the pin’s diameter. To unlock the slider,
click the lock icon.
Clearance Height 4}
m: Slider to set the anchor pin mount’s clear-
ance height.
Use the Reload Preset button 2} mto reset a preset to its original
state. Use the checkbox Auto Save Preset 3}
m to automatically save
4}
m 1}
m
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2}
m Create more presets by adjusting the sliders in the tabs Sleeves
3}
m and Anchor Pins and save them by right-clicking the upper drop-
down menu 4} m in the Printer Presets tab. Choose a name for your
preset(s) that contains no special characters. The custom presets
Figure 18.10: Design Sleeve Mounts win- are saved to a directory on your hard drive which can be opened by
dow: Printer Presets tab right-clicking the upper dropdown menu 4} mand selecting the cor-
responding option Open preset folder.
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1}
m
Design the surgical guide’s bottom using the sliders in the Properties tab.
2}
m Block out undercuts
Offset 1}
m: Set an offset from the teeth to the bottom surface.
Allow undercuts up to 2} m : Set a maximum value for allowed
3}
m
undercuts. Undercuts are displayed on the surgical guide bot-
4}
m
tom in colors.
Bottom properties
Smoothing 3} m : Set a value for smoothing the surface. The
higher the value, the smoother the surface.
5}
m
Anticipate milling 4} m : When milling the guide, this setting
ensures that the drill head with its particular drill head diam-
eter reaches each part of the guide’s bottom side. Adjust the
Diameter slider to define the drill head diameter to be used.
Click Apply 5} m to apply changes in the properties and to generate the sur-
gical guide’s bottom. Once generated, the bottom is displayed on the jaw
scan with colored undercut visualization as shown in Figure 18.12.
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WARNING
The Offset value in the Block out Undercuts section is dependent on the material/printer com-
bination used for surgical guide manufacturing and requires experience with used material and
equipment. Wrong settings result in an ill-fitting surgical guide.
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NOTE
The accuracy of the desired offset of the surgical guide bottom to the jaw scan is 0.1mm in smooth
areas. In regions with spikes (typically scan data artifacts), the offset may deviate by a larger value.
Insertion Direction
While in Properties tab, the green arrow in the main view shows the insertion direction.
2}
m 1}
m
Figure 18.13: Functions to set the insertion Figure 18.14: Insertion direction
direction
Set the insertion direction by dragging the top of the arrow. Alternatively, you can set the insertion direction from view: set
the view so that you look onto the scan from the desired insertion direction (clicking the icon 1} mnext to Set insertion
direction from view sets the view to the current insertion direction) and click Set insertion direction from view 2} m.
Click Apply to apply a new insertion direction and to generate the surgical guide’s bottom.
WARNING
Carefully inspect the impact of a particular setting of the insertion direction (e.g., blocking or al-
lowing undercuts or smoothing of the bottom). Inappropriate settings may result in an ill-fitting
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surgical guide.
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HINT
The tooth-supported surgical guide should have enough (non-blocked) support on the occlusal
surface of the neighboring teeth. Ideally, the tooth surface is not blocked out from the occlusal
surface down to the equator. For gingiva-supported guides for edentulous cases, use anchor pins
to ensure a stable fit of the surgical guide.
18.6.2 Free-forming
Using the functions in the Free-forming tab, you can free-form the surgical guide’s bottom as described in Chapter 21.5.1.
By unchecking Show Brush, you can hide the brush visualization.
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You can move points on a margin line by dragging them with your mouse. To delete a point, hold the left mouse button and
right-click the point. To add a point, click the margin line at the desired position.
4}
m
Click Apply 4}
mto initiate the surgical guide top gen-
eration.
3}
m
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You can still edit the margin lines once the surgical guide
top is generated. If parts of the surgical guide top col-
lide with the planned implant, or reach into the area
above the drilling sleeve which should remain clear for
drilling tools as per definition in the Design Surgical
Guide Sleeve Mounts step (see Chapter 18.5), these parts
will be cut off automatically when finalizing the surgical
guide design. You do not have to remove them manually.
WARNING
Insufficient connection of the surgical guide top to the sleeve mount may cause the surgical
guide to bend or break during the surgical procedure.
For tooth-supported surgical guides, do not include soft tissue (e.g., gingiva) in the design of
the surgical guide top while defining the surgical guide top margin line.
HINT
Check the thickness of the surgical guide when the surgical guide has been merged into one
piece. If you are not satisfied with the merged surgical guide or have doubts about the stability
of the merged surgical guide, go back to Design Surgical Guide Top and redraw the margin
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line or increase the thickness of the surgical guide. Additionally, you can increase the radial
thickness of the sleeve mount in the Design Sleeve Mounts window.
Include sufficient undercuts during definition of the margin line of the surgical guide top for
a proper retain of the surgical guide.
The contact surface of the surgical guide with the remaining dentition must be sufficient for
a stable fit.
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WARNING
Use the attachment function with care because it may impact the stability and fit of the surgical
guide.
2}
m
1}
m
3}
m
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HINT
Preferably choose several but smaller inspection windows and check the thickness of the surgical
guide when the surgical guide has been merged into one piece. Go back and change inspection
windows if you are not satisfied with the merged surgical guide or have doubts about the stability
of the surgical guide.
Once you have set a window/support/text, you can still change its position by dragging it with your mouse. To add a new
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window/support/text, click New. To delete a window/support/text, click Delete. Click Delete all to delete all existing sup-
ports/windows/text.
To view a preview of the result, click Preview. Clicking this button again will bring you back to editing mode. The sup-
ports/windows/text will finally be applied when proceeding to the next workflow step (Merging and Saving).
1}
m
2}
m
3}
m
4}
m 5}
m
6}
m 7}
m
To delete a mount connector, select it in the main view and click Delete 5}m. Click Delete all 6}mto delete all existing mount
connectors. Click the Preview button 7} m to generate a preview of the merged surgical guide.
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18.8.4 Shortcuts
You can use the following shortcuts to scale the placed attachments:
Window / support structure:
SHIFT + mouse wheel: length scaling
CTRL + mouse wheel: thickness scaling
SHIFT + left mouse button: uniform scaling
CTRL + SHIFT + left mouse button: direction-based scaling
CTRL + Arrow keys Up/Down: Rotate a window/support structure in 15° steps.
Mount connectors:
SHIFT + mouse wheel: change the minimum area size
Text:
SHIFT + mouse wheel: size scaling
CTRL + mouse wheel: thickness scaling
exoplan merges all parts of the surgical guide into one single mesh and saves it as stl file in the project folder when generating
the surgical guide result files (See chapter 18.15). If you are planning implants in both the upper and lower jaw, exoplan creates
two surgical guide meshes in this step, one for each jaw.
Note that if the merged surgical guide consists of multiple parts, exoplan will display a warning dialog, prompting you to
decide whether you want to proceed in the workflow or return to the merging step.
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NOTE
The fit of the surgical guide on the surgical guide bottom has an accuracy of 0.01mm in smooth
areas. In regions with spikes (typically scan data artifacts), the fit may deviate by a larger value.
Note that exoplan will display a warning dialog upon selecting Next if the merged surgical guide for an edentulous case does
not contain any anchor pins. The dialog prompts you to decide whether you want to continue in the workflow without placing
anchor pins retroactively or whether you want to switch to Expert mode to place anchor pins. (see Figure 18.25).
Figure 18.25: Warning dialog shown if no anchor pins were placed (edentulous case)
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Step 1: Check for detached mesh parts by selecting the prosthesis mesh with the option Select by click on surface and
invert the selection. If the Delete button is enabled, floating parts are selected and should be removed by clicking
Delete.
Step 2: Check if there are connected mesh artifacts on the outside of the prosthesis that might result from noise, beam
hardening artifacts and streak artifacts in the CT dataset of the prosthesis. Select and remove them individually.
At the end, select the prosthesis and click on Close holes. Use free-form tools to smooth affected areas if
necessary.
Step 3: In secondary views, check for remaining mesh artifacts within the prosthesis mesh that are connected with the
prosthesis mesh (see Figure 18.26). Use the option Select only surface and select the mesh surface section
where the mesh artifacts are connected to. Delete the selection to detach the mesh artifacts from the prosthesis
mesh. Select the prosthesis mesh with the option Select by click on surface and invert the selection. This will
select the detached mesh artifacts. Finally, delete these mesh artifacts, select the complete prosthesis mesh, and
click on Close holes. Use free-form tools to smooth affected areas if necessary.
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Note that exoplan will display a warning dialog upon selecting Next if intersections in the bottom of a free-formed tooth-
supported surgical guide are detected. The dialog prompts you to decide whether you want to continue in the workflow with
intended intersections or whether you want to return to the Free-forming step to resolve the intersections (see Figure 18.28).
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Figure 18.28: Warning dialog shown if intersections in the surgical guide bottom are detected (tooth-supported case)
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In this workflow step, there is a check between the clearance object and the free-formed guide.
In this workflow step, there is a check between invasive parts (implants and anchor pins) and free-formed guides.
If you proceed with Continue for at least one of these warning messages, a corresponding entry will be written into in
the Surgical Protocol.
WARNING
Use the Free-Form tool with care because it may impact the stability and fit of the surgical guide.
HINT
You will directly see the impact of free-forming the merged surgical guide’s geometry. Carefully
check the free-forming results and preferably add material. When smoothing or removing mate-
rial, carefully check the result for sufficient stability and undo any changes if you are in doubt or
not satisfied with the result.
In the Anatomic tab, you can edit a Small region or a Large region of
the surgical guide by selecting the corresponding button. Click the merged
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surgical guide in the main view and drag your mouse. You can adjust the
thickness visualization as in the Free-Form tab.
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Select Create surgical guide output data if you want to skip the
creation of a fixation guide.
exoplan will merge the anchor pin mounts and fixation guide attach-
ments into the prosthesis mesh. Sleeves and attachments only de-
fined for the surgical guide will not be merged into the prosthesis
mesh.
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When you enter this Wizard step, merging of the fixation guide design is ini-
tiated automatically. You can abort the merging process by clicking Can-
cel Merging or restart it by clicking Restart Merging. exoplan merges all
parts of the fixation guide into one single mesh and saves it as stl file in the
project folder when generating the surgical guide result files (See chapter
18.15).
Note that if the merged fixation guide consists of multiple parts, exoplan
will display a warning dialog, prompting you to decide whether you want
to proceed in the workflow or return to the merging step.
HINT
If the merging of the fixation guide fails for edentulous cases, follow the instructions in Chapter
18.9.1.
In this Wizard step, you can free-form the merged fixation guide(s) as de-
scribed in Chapter 18.10.
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When you enter the step Generate Surgical Guide Result Files, exo-
plan automatically generates the surgical guide result files and .stl files of
the merged surgical and fixation guide(s) (if available) as well as the de-
fined gingiva contact surface (if available) and saves them to the project
directory. The scene and a corresponding screenshot are also saved to the
project directory after the surgical report has been created.
18.15 Selecting the next step after generating the Surgical Guide Result Files
3}
m
4}
m
Once the surgical guide result files are generated, you can select to view
the surgical report 1}mor to open the project directory 2} m . If you have
created surgical guide result files and apply certain critical changes to the
corresponding implant planning or the surgical guide design afterwards,
exoplan will delete those surgical guide result files.
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I’m done 3}
m: Close exoplan.
1}
m
Expert Mode 4}
m: Enter Expert mode.
2}
m
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WARNING
In the US, the physical surgical guide for endosseous dental implant placement is a medical device
to be manufactured at an FDA registered and listed manufacturing location. Please contact the
FDA for information regarding the regulatory status and requirements related to manufacturing
these surgical guides.
WARNING
Verify the surgical guide before usage.
WARNING
Validate the surgical report document before commencing the surgical procedure.
Do not modify the files created for the manufacturing of the surgical guide.
You must carefully study the surgical report.
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Step 1: Click Save in the main toolbar (see Chapter 24.1), or right-click the background in the main view and select Save
scene as in the context menu (see Chapter 24.3).
Step 2: Save the scene in the desired directory.
exoplan automatically saves a screenshot for each saved scene file to the project folder. You can disable the automatic saving
of screenshots in the exoplan settings (see Chapter 26.7).
If scene files already exist for the current project, you must decide how to proceed in the dialog shown in Figure 19.1.
You can save a scene also as STL, OFF, OBJ, and as point cloud formats. To do this, select Save scene as in the context menu
(see Chapter 24.3) and select the desired format from the file format dropdown list in the explorer window.
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You can use exoplan in two modes: Wizard mode and Expert mode. Wizard mode guides you through the worksteps, whereas
in Expert mode you can jump freely between workflow steps.
To switch between Expert and Wizard mode, click Wizard / Expert in the main toolbar (see Figure 20.1). You can switch from
Wizard to Expert mode any time, however switching from Expert to Wizard mode is only possible if no workflow step is open.
When returning to Wizard mode, the Wizard will start at the point where you left it.
See Chapter 24.2 for a detailed description of the available Expert toolbar options.
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The window header shows the current workflow step. Clicking the ? symbol opens the exoplan User Manual.
The main window section are explanations and functions for performing the current workflow step (same in both windows).
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The DICOM series selection dialog and the DICOM Control are opened automatically.
You cannot return to this Wizard step once you continue in the workflow.
You can adjust the automatic panoramic curve definition in Wizard- and Expert mode.
Select CT Alignment Select the CT alignment workflow for your project (see Chapter 8).
Workflow
CT Data Alignment Align CT data to the jaw scan or another alignment object (see Chapter 9).
This Wizard step only appears if you loaded at least one alignment object and selected
CT to Mesh Alignment in the step Select CT Alignment Workflow.
Clicking Next during 3-point alignment will perform the 3-point alignment and take
you to the best fit alignment. Clicking Next during best fit alignment will perform the
best fit alignment. Clicking Back during best fit alignment will bring you back to the
3-point alignment.
CT-to-CT Alignment Align CT data to the patient’s prosthesis CT data (see Chapter 10).
This Wizard step only appears if you loaded at least one alignment object and selected
CT-to-CT Alignment in the step Select CT Alignment Workflow.
exoplan will prompt you to load a prosthesis CT dataset before proceeding to the
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Change Implant Setup This step only appears if no implants are defined in your project. Define at least one implant
to continue (see Chapter 11).
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Sinus Segmentation Define sinus areas as collision objects (see Chapter 13).
This Wizard step only appears when planning implants for tooth numbers 24-28 or
14-18.
Place Model Teeth Place tooth models initially (see Chapter 14).
If you have loaded a waxup scan, this Wizard step (and the next Wizard step) will not
appear.
If you have defined only one bridge in your project, clicking Next takes you to the next
Wizard step. If you have defined multiple bridges, clicking Next takes you to the next
bridge (in sequence from lowest to highest tooth number).
This Wizard step only appears if you have placed tooth models initially in the previous
step.
Implant Positioning Position implants, prosthetic components, sleeves, and anchor pins (see Chapter 16).
Generate Implant Generate the planning result files (see Chapter 17).
Planning Files
This Wizard step is available if you have positioned all implants in the previous step.
Select Base Mesh For Select or load the base mesh(es) for the surgical guide (see Chapter 18.3).
Guide Design
Defining the Gingiva This Wizard step only appears if your project contains a prosthesis mesh that will be used as
Contact Surface surgical guide base (see Chapter 18.4).
Design Sleeve Mounts Design the mounts for the planned drilling sleeves and define the settings for placed anchor
and Anchor Pins pins (see Chapter 18.5).
Design Surgical Guide Design the bottom of the surgical guide by blocking out undercuts, setting the insertion
Bottom direction, and using free-forming tools (see Chapter 18.6).
Designing the Surgical Define the shape of the surgical guide’s top (see Chapter 18.7).
Guide Top
Adding Attachments Stabilize the surgical guide with supports, add inspection windows and text attachments to
the surgical guide (see Chapter 18.8).
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Merging the Surgical exoplan automatically merges and saves the designed surgical guide into one single mesh
Guide (see Chapter 18.9).
Free-Forming the Use free-forming tools to adjust the shape of the merged surgical guide (see Chapter 18.10).
Merged Surgical Guide
Creating a Fixation Design a separate fixation guide to be used in guided surgery (see Chapter 18.11).
Guide
Merging the Fixation exoplan automatically merges and saves the designed fixation guide and its attachments
Guide into one single mesh (see Chapter 18.12).
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Free-Forming the Use free-forming tools to adjust the shape of the merged surgical guide (see Chapter 18.13).
Merged Fixation Guide
Generating the exoplan automatically generates the surgical guide result files (see Chapter 18.14).
Surgical Guide Result
Files
You cannot save a scene in Wizard mode. See Chapter 19.1 for information on how to save a scene.
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21 Expert features
This chapter lists all features that are exclusively accessible in Expert Mode.
The patient’s axial direction is not necessarily equal to the occlusal direction.
2}
m 3}
m
1}
m
4}
m
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1}
mMain view (see Chapter 21.1.1)
2}
mDICOM Control (see Chapter 21.1.2)
3}
mSecondary views (see Chapter 21.1.3)
4}
mAxial and View Direction window (see Chapter 21.1.4)
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Function Description
Front view Display the DICOM series visualization from the front. See Chapter 21.1.5
Side view Display the DICOM series visualization from the left side. See Chapter 21.1.5
3D view Display the DICOM series visualization cut from the top. See Chapter 21.1.5
Reset patient directions Reset axial and view direction to the initial positions.
OK Complete the step, save all your settings, and close the window.
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Function Description
Cancel Abort the step and close the window. All changes made since you entered the axial and
view definition step will be discarded.
21.1.5 Step-by-Step
You can use three views to define the axial and view direction:
Front view
In the Front view, the main view shows the DICOM series visualization from the front. A coordinate system with the two axes
Axial direction and Left Direction is displayed. The view direction points towards the camera. Change the view direction
by rotating the DICOM series visualization (see Chapter 1.12). You can use the Front mode to define the patient directions so
that you are looking towards the view direction of the patient.
Side view
In the Side view, the main view shows the DICOM series visualization from the left side. A coordinate system with the two axes
Axial direction and View Direction is displayed. The left direction points towards the camera. Change the view direction
by rotating the DICOM series visualization (see Chapter 1.12). You can use the Side view to define the patient directions so
that you are looking towards the left direction of the patient.
3D view
In the 3D view, the main view shows the DICOM series visualization cut from the top. On the section plane, a coordinate sys-
tem with two axes Axial direction and View Direction is displayed. A light round area around the DICOM series visualization
indicates the currently defined section plane.
If the suggested directions do not match the actual situation in your DICOM series, adjust the axial and view direction using
the control elements displayed in the main view. The section plane slider and origin position point are only visual indicators
to help you determine the correct view and axial direction. Their positions will not be saved.
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1}
m
4}
m
3}
m
2}
m
To change the axial direction, click and drag the marker at the top of the Axial Direction arrow 1}
m. This will tilt the
section plane.
To change the view direction, click and drag the marker at the top of the View Direction arrow 2}
m. This will rotate the
view direction axis around the axial direction axis.
Drag the marker in the section plane slider 3}
mto change the section plane’s position in vertical direction.
Drag the origin position point 4m
}to change the coordinate system’s location on the section plane.
If you already defined the panoramic curve and change the data orientation in this step, the panoramic curve becomes invalid
and you must redefine the panoramic curve.
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Step 1: Select the implant you want to delete by clicking it in the main view. To select more implants for deletion, hold
CTRL while clicking additional implants. If you do not select specific implants, all implants will be selected for
deletion.
Step 2: Click Delete Implant in the Expert toolbar or the context menu. This opens the implant deletion dialog (see
Figure 21.4) which lists the tooth numbers for the implants you are about to delete. In the main view, the listed
implants will be highlighted in yellow.
Step 3: Click OK to confirm.
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21.3 Deleting Constructed Parts (Tooth Models, Drilling Sleeves, and more)
Step 2: Select the parts to delete from the Delete: dropdown menu. The Parts to delete section lists the parts which
will be deleted. You cannot select individual items in the list.
Step 3: Click OK to confirm.
When deleting certain constructed parts (e.g., mandibular nerve canals), existing planning result files must be deleted to
proceed.
¹Deleting drilling sleeves separately is only possible if the Surgical Guide Module is activated
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WARNING
The jaw scan might no longer correlate to the anatomical situation in the patient’s mouth if the
virtual tooth extraction was performed after the guide design workflow has started.
6}
m
5}
m
4}
m
1}
m 2}
m 3}
m
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Step 1: Decide whether you want to extract and remove the tooth, or also want to copy it.
If you only want to extract the tooth from the jaw scan, select No Copy 1}
m.
If you want to copy the tooth, choose whether to copy the extracted tooth as Virtual pre-op 2m
}or Direct
Copy 3} m.
Step 2: Select the tooth you want to extract by left-clicking the jaw scan.
When copying a tooth, exoplan displays a dental arch in a separate window. Select the tooth number that
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7}
m
8}
m
9}
m
In the Margin tab of the Extract Tooth window, you can redefine the
margin of the tooth to be extracted by moving and/or placing control
points. You can move points on the margin line by dragging them with
your mouse. To delete a point, hold the left mouse button and right-click
the point. To add a point, click the margin line at the desired position.
1}
m Keep Surface Selection 1} m: Activate to use the surface area
2}
m
shown in the Correct tab. When deactivated, exoplan will re-detect
3}
m the surface area of the scan data based on the defined margin.
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In the Correct tab of the Extract Tooth window, you can optimize the
tooth detection by defining areas on the jaw scan with a brush tool.
When you open the 3D surface editor by right-clicking the background of the main view, all applicable meshes are visible
and can be edited. When you open the 3D surface editor by right-clicking on a particular applicable mesh type, only this
applicable mesh is visible and can be edited. All other objects are hidden.
If you have already finished the CT alignment and the CT alignment object was subsequently modified with the 3D surface
editor, a warning message appears informing you about the influence on the surgical guide fitting and the accuracy of the
implant placement. You can either select Continue and accept the modification, or Cancel and discard the modification.
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NOTE
If you modify the CT alignment object during implant planning and after the CT alignment,
this will be mentioned in the implant planning report.
If you modify the CT alignment object after the implant planning is finished, exoplan deletes
the implant planning report and surgical report. They need to be generated again to finish
the implant planning and surgical guide workflow.
You can free-form the mesh as described in Chapter 21.5.1, or crop the mesh as described in Chapter 21.5.2.
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21.5.1 Free-forming
SHORTCUTS
1 Activate Add/Remove
2 Activate Smooth/Flatten
4 Small region (when free-forming a merged surgical guide or merged fixation guide)
5 Large region (when free-forming a merged surgical guide or merged fixation guide)
F2 Select default brush type
F3 Select point of knife brush type
F4 Select cylinder brush type
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NOTE
exoplan’s mesh edit tools are used for modification of meshes generated from the isosurfaces vi-
sualization of the CT scan data. exoplan does not enable the editing of CT scan data.
1}
m
2}
m
3}
m
4}
m
There are two methods to mark areas on the CT mesh for cropping actions:
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Method A: by defining a straight line on the screen that goes straight through the mesh. The area on the side pointed
to by an arrow defines the marking area on the mesh.
Method B: by defining a closed contour on the screen over the mesh. The enclosed part of the contour defines the
marking area on the mesh.
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would continue.
You can also combine the two drawing
techniques in one contour.
Step 2: Double-click to close the shape. The marked shape is displayed in orange.
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To demark areas in a marked zone, use the same techniques as described in Method A and B while holding SHIFT.
When you have marked a region on the mesh, all functions in the 3D Surface Editor window become active .
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Function Description
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Function Description
Invert Invert the markings (unmarked areas become marked, marked areas become
unmarked).
Delete Delete the part of the mesh you have marked (Hotkey: DEL).
Cut Cut out the marked part of the mesh. You can combine all cut out parts into a new mesh.
Close Holes Close all holes in the selected part of the mesh. If no selection is present, close all holes
that are smaller than the size threshold (adjust the threshold by clicking the dropdown
arrow).
Cancel Close the 3D Surface Editor window, discard all cropping actions.
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The Rapid Pre-Planning mode focuses on investigating the patient anatomy and implant placement without completing
regular planning steps such as CT alignment or nerve definition.
To start Rapid Pre-Planning mode, load or create a project in exoplan DB and click Rapid Pre-Planning in the Actions side-
bar. Note that you are not asked if you want to load existing scenes when loading a project file.
To change the view arrangement, you can use the view presets in the main toolbar (see Chapter 23.8), or the Implant Control
(see Chapter 25.2).
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1}
m
Step Reference
Define Mandibular Canal Only available when working on the lower jaw. See
Chapter 12
Sinus Segmentation Only available when working on the upper jaw. See
Chapter 13
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3}
m Save scene and close software 2} m : Specify the scene filename
and save the current planning scene. exoplan will be closed after
4}
m saving the scene.
I’m done 3}
m: exoplan will be closed without saving the planning
scene.
Expert Mode 4}
m: exoplan switches from Wizard mode to Expert
mode.
Note: As soon as you continue to finalize the planning, the currently se-
lected DICOM dataset cannot be changed anymore.
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23 Views
The available and displayed views in exoplan depend on the progress in the workflow and on the current workflow step.
There are two types of views:
1. Main view (see Chapter 23.1)
2. Secondary views (see Chapter 23.2)
In certain workflow steps, exoplan arranges the main view and the secondary views automatically, e.g., when defining the
mandibular canal (see Chapter 12). You can change the view arrangement using the Implant Control (see Chapter 25.2) or by
choosing a different view preset (see Chapter 23.8).
Figure 23.1: Main view showing DICOM series visualization and scene objects
The main view can show all elements you created or loaded. You can show/hide these elements (so-called scene objects)
using the Group Selector (see Chapter 25.1).
The main view can show:
DICOM series visualization (adjustable via DICOM Control, see Chapter 5)
optical scans (e.g., jaw scan, antagonist scan)
library tooth models
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mandibular nerves
implant parts
other objects (e.g., annotations, collision objects, insertion channels, etc.)
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Function Description
Hold right mouse button and drag Rotate the view around the rotation center (center of currently available scene
objects by default)
Right-click outer frame and drag Rotate the view around the view axis which is running through the rotation
center (center of currently available scene objects by default)
Click middle mouse button / mouse Center view and set new rotation center
wheel
Hold both mouse buttons and drag Move the view freely
Arrow keys Move the view in the respective arrow directions. Hold SHIFT for fast
movement, CTRL for slow movement, or SHIFT + CTRL for very slow
movement.
Page up, page down Rotate the view horizontally around pivot
SHORTCUTS
At the bottom of the main toolbar (see Chapter 24.1), view perspective buttons are avail-
able. Click these buttons to set certain predefined view perspectives. Click the on head
to centrally display the currently set view perspective in its entirety.
The main view functions are not available in the panoramic curve definition step (see
Chapter 7).
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Figure 23.2 shows the main view with the DICOM series visualization and view indicators of the axial view and the curve cut
view.
1}
m
3}
m
2}
m
Figure 23.2: Main view with DICOM series visualization and view indicators
1}
mAxial view indicator
2}
mCurve cut view indicator
3}
mView intersection marker
Show/hide view indicators in the secondary view visualization settings (see Chapter 23.2.3).
A cursor indicator in the view-specific color displays the current mouse position in a secondary view (see Figure 23.3). It is
also displayed if the view indicator is hidden.
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5}
m
6}
m
1}
m
7}
m
8}
m
9}
m
3}
m
10}
m
4}
m
1}
m 6}
m
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2}
mFrame 7}
mScreenshot button
3}
mRuler for size indication 8}
mMeasurement Tool
4}
mOrientation preview 9}
mVisualization mode buttons
5}
mVisualization settings menu 10}
mShow/Hide cut texture button
The secondary view’s main part 1} mshows the 2D sectional view of the DICOM series and scene object visualizations. In
sectional views, you can change the cut position using the view-specific functions (see view-specific chapters). Furthermore,
you can change contrast and brightness settings for improving the visualization, if necessary (see Chapter 23.2.5).
Other secondary view elements:
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Each secondary view has a uniquely colored frame 2} m . The frame color is also used for the view indicators in the main
view (see Chapter 23.1.2), for the view intersection markers (see Chapter 23.2.6), for the view indications in the Implant
Control (see Chapter 25.2), and in the view presets of the main toolbar (see Chapter 23.8). For orientation purposes,
the upper right corner of the frame is visualized in the main view.
The orientation preview 4} m shows the current orientation of the 3D DICOM series visualization. The perspective is as if
you are looking onto the cross-sectional plane. If you move the cross-section’s location, the orientation preview moves
accordingly. This feature is not available in the panorama view.
Using the visualization settings menu 5}m , you can define settings for the secondary view visualization and its repre-
sentation in the main view (see Chapter 23.2.3).
Using the focus button 6}m , you can set the view as focused view (see Chapter 25.2.1 for details on view arrangements).
Clicking the focus button in a focused view unfocuses the view and puts the main view in focus.
Using the screenshot button 7} m , you can take a screenshot of the current secondary view. The screenshot is saved
automatically and is added to the Screenshot and Image Management tool (see Chapter 26.4).
You can open the measurement tool from the secondary views by clicking the corresponding button 8} m . Measure-
ment points can only be placed in one secondary view or in the main view. Note that this button is not available in the
panorama view. See Chapter 26.1 for detailed information about the measurement tool.
Using the visualization mode buttons 9}
m, you can define the visualization mode of sectional views (see Chapter 23.2.4).
Show/hide the cut texture using the corresponding button 10m
}.
Setting Description
Clip CT data by cut plane Clip the 3D DICOM series visualization in the main view at the current secondary
view position.
Turn Around Turn the view 180 degrees in horizontal direction, so that you can quickly switch
the view to the opposite side. Also turns around the cut plane in the main view, if
Clip CT data by cut plane is activated.
X-ray noise threshold slider Change the noise threshold value for the X-ray visualization of the panorama
view (see Chapter 23.5).
Show Indicator Show/hide the view indicator in the main view (see Chapter 23.1.2).
Show View Intersection Markers Show/hide intersections with other currently active secondary views (see
Chapter 23.2.6).
Hide all Indicators Show/hide all view indicators and intersection markers (see Chapter 23.1.2).
Align to other implant cross view Reset the implant cross views to be perpendicular to each other (see Chapter
23.6). Only available when both implant cross views are active.
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Setting Description
Show invasive part as 3D surface Display the currently focused invasive part in 3D (only available in implant cross
views).
In the panorama view, only X-ray noise threshold, Show Indicator, Show View Intersection Markers, and Hide all In-
dicators are available.
Solid 1}
m
Solid (natural) 2}
m 3}
m
To display the secondary view’s visualization as a texture in the main view, click
the texture visualization button 3}m .
In the Implant cross views, a third visualization mode is available; see Chapter 23.6. The panorama view has special visual-
ization modes; see Chapter 23.5.
To change the brightness, hold CTRL and scroll the mouse wheel. This changes the position of the currently displayed
CT data window.
To change the contrast, hold SHIFT and scroll the mouse wheel. This changes the size of the currently displayed CT
data window.
The panorama view has special contrast/brightness settings; see Chapter 23.5.3.
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1}
m
2}
m
1}
mCoronal view intersection marker
2}
mSagittal view intersection marker
You can change the cut position of a corresponding secondary view by dragging the spheres at the intersection marker’s ends.
These spheres are not available for all intersection markers.
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(c) Coronal
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Function Description
You can use the axis-oriented views to check and evaluate the result of the CT data alignment (see Chapter 9.3.1). If the
alignment object (e.g., jaw scan) visualization fits the anatomical structures in the DICOM series visualization (i.e., jaw outlines
fit well the tooth shape), this is an indicator for the alignment being accurate.
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Function Description
Hold mouse wheel + move mouse Drag the view. In curve tangent view, vertical dragging is
restricted to the panoramic curve’s course
Hold right mouse button + move mouse right/left Move sectional/tangential along panoramic curve
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You can use the panoramic curve-based views to check and evaluate the result of the CT data alignment (see Chapter 9.3.1).
If the jaw scan visualization fits the DICOM series visualization well (jaw outlines fit well the tooth line), this is an indicator
for the alignment being accurate.
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1}
m
The panorama view has special visualization modes:
Cut mode 1}
m
X-ray 2m
} 2}
m
To display the panorama view as a texture (cut mode visualization) in the main
view, click 3}
m.
X-ray mode is the well-known panoramic X-ray image. Cut mode shows a
panoramic curve-shaped cross section view of the DICOM series. 3}
m
Function Description
X-ray mode: Hold right mouse button Switch to cut mode (+ move mouse up/down to move
between depth indication lines)
Cut mode: Hold right mouse button + move mouse Change the cut position (shape-preserving)
up/down
In the panorama view, only implants (with attached parts), sleeves, anchor pins, and mandibular canals can be displayed.
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Hold SHIFT and scroll the mouse wheel to change the contrast (change DICOM window size)
Figure 23.12: Implant-based views with implant visualization and jaw scan visualization
In addition to the default visualization modes (see Chapter 23.2.4), the Implant
cross views have a third visualization mode: solid threshold cut mode 1}m . In this
mode, the DICOM series visualization is colored red and blue according to the den-
1}
m
sity threshold automatically defined by exoplan. Note that you can manually de-
fine the density threshold in Expert mode. (See Chapter 6).
Function Description
Implant cross 1 & 2: Rotate the view around the implant axis
Hold right mouse button + move mouse right/left
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If you have positioned multiple implants, you can change the implant focused in the implant-based views by double-clicking
the desired implant in the main view.
In the implant positioning step, you can enable density threshold coloring
for implants (see Chapter 16). The density threshold will be visualized in
the Implant cross view. This can help you to determine if you have posi-
tioned the implant in a potentially dense enough area.
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Function Description
Hold right mouse button + move mouse up/down Move along the view axis
exoplan uses the view-specific frame colors to illustrate the arrangement in the view preset buttons.
The available view preset buttons may vary depending on the progress in the workflow and on the current workflow step.
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24 Menus
The main toolbar is always displayed at the right side of the exoplan screen. Figure 24.1 shows 13}
m
the main toolbar with all possible options. These are only available if a project is loaded, and 1}
m
partially dependent on the workflow progress.
1}
mSave current scene (see Chapter 19.1)
2}
m
2}
mSwitch to Wizard/Expert mode (see Chapter 20). Right-clicking shows additional options.
3}
mAccess tools (see Chapter 26) 3}
m
4}
mActivate/deactivate TruSmile (realistic rendering and display of tooth models). Right-
4}
m
clicking offers the Plaster option, which displays teeth (e.g., from a library) like a scanned
model. Only available if the TruSmile module is activated.
5}
m Show/hide Implant Control (see Chapter 25.2) 5}
m
6}
mShow/hide Group Selector (see Chapter 25.1)
7}
mShow/hide DICOM Control (see Chapter 5) 6}
m
8}
mOpen user manual
9}
mView preset buttons (see Chapter 23.8) 7}
m
10}
mToggle incognito mode (see Chapter 26.7)
11}
m Smile Design View button (see Chapter 3.2.1) 8}
m
12}
mView perspective buttons (see Chapter 23.1)
13}
mDisplay your exocad account information, visit your profile, log out, or add another account 9}
m
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10}
m
11}
m
12}
m
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1}
m 2}
m 3}
m
1}
mAccess workflow steps
2}
mDelete implants (see Chapter 21.2)
3}
mDelete constructed parts (see Chapter 21.3)
The available options in the context menu depend on whether you are in Wizard or in Expert mode (see Chapter 20). In
Wizard mode, only the Save scene as option (see Chapter 19.1) and the Close project option (see Chapter 19.2) are available.
In Expert mode, you can also access the workflow steps and other options.
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25 Controls
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by Hide all, which will hide all scan data and tooth axes.
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SHORTCUTS
Alt + V: Show/Hide Group Selector
The following keyboard shortcuts toggle the visibility of the corresponding scene objects:
A: antagonist
S: Jaw scan or prosthesis scan
M: Merged parts (merged parts must exist)
E: Anatomic parts (tooth models)
W: Waxup scans
D: DICOM
P: Pre-op scan
CTRL + middle-mouse button hides the object under the mouse pointer, CTRL + SHIFT + middle-
mouse button shows it again. SHIFT + middle-mouse button toggles the transparency of the ob-
ject under the mouse pointer.
WARNING
Ensure that all scene objects necessary for evaluating a scene are activated for visualization in the
Group Selector.
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Select/deselect available secondary views for display by clicking the corresponding buttons in the Secondary Views section.
Select the view arrangement in the Arrangement section:
Singular: Displays only one selected secondary view or the main view.
Partitioned: Displays the selected views in equal-sized sections.
Focused: One of the views is the focused view in the left screen section, the other views are arranged in the right screen
section. You can change the focused view in the secondary view settings (see Chapter 23.2.1).
Panorama: The panorama view is displayed in the bottom left screen section. The arrangement of additional views is as
with the focused arrangement, with the main view as focused view. If you change the focused view (see Chapter 23.2.1),
the Implant Control will automatically deactivate the panorama arrangement and activate the focused arrangement.
In the Options section, you can
synchronize the panoramic curve-based views curve cut and curve tangent by checking Sync curve attached views.
This means that when moving one of these views, the other will move accordingly.
synchronize the implant-based views Implant cross 1 & 2 by checking Sync implant cross views. If checked and you
rotate one of the views, the other view is rotated at the same amount and the angle between the two views remains. If
unchecked, you can rotate both views independently from each other.
select Save current view arrangement to save the selection and arrangement of secondary views for the current
workflow step. In certain workflow steps (e.g., Implant Positioning), you can also create and save arrangements for
the different sub steps (e.g., initial implant placement, Implant positioning). Each time the current workflow step is
entered, the saved setting is used. Delete a saved arrangement and restore the default arrangement by clicking the
brush button.
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NOTE
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The Implant Angles tab shows angles between the occlusal axes of the implants, as shown in Figure 25.6. Implants in the
upper jaw are listed on the left, while implants in the lower jaw are listed on the right.
In this example, the angle between Implant 15 and Implant 13 is 11.3°. You can highlight angles between a specific implant
and the other implants by clicking a Tooth number. In the example, implant 23 is selected and the angles between implant
23 and implant 15, implant 13, and implant 25 are highlighted.
The Topmost part Angles tab shows angles between prosthetic connections of used parts, as shown in Figure 25.7. Implants
in the upper jaw are listed on the left, while implants in the lower jaw are listed on the right. If a normal titanium base or a
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normal stock abutment is used, the angles should not differ from the implant angles. However, if an angled (multi unit)
abutment or an implant with an angled prosthetic connection is used, there should be a difference to the implant angles
listed in the Implant Angles tab.
In this example, the angle between the superstructure of Implant 44 and Implant 46 is 8.2°. You can highlight angles between
a specific implant superstructure and another implants’ superstructure by clicking a Tooth number. In the example, the su-
perstructure of implant 26 is selected and the angle between the superstructure of implant 26 and implant 25 is highlighted.
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26 Tools
Access the tools in the main toolbar (see Chapter 24.1) by clicking Tools.
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WARNING
When measuring distances in secondary views, be aware of the limitations of measurements in a
2D image plane within 3D space, e.g., when measuring a distance between two objects.
NOTE
The accuracy of measuring distances, angles, and bone density depends on the accuracy of the
input data. When measuring distances/angles between CT data and mesh objects, the accuracy
depends additionally on the accuracy of the alignment.
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1}
mMeasure distances (see Chapter 26.1.1) 8}
mFreeze the current measurement
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mMeasure angles (see Chapter 26.1.2) 9}
mAdd another measurement
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mMeasure bone density (see Chapter 26.1.3) 10}
mClear all defined points
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mShow a list of all measurements (see Chapter 26.1.5) 11}
m Show/hide arrows
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mDisplay scene objects semi-transparent (no effect on
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mSet the end point (double-click to delete) DICOM series visualization in main view)
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mEstimated Measurements
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mLock the current situation
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mCreate annotations from the result (see Chapter 26.1.4)
NOTE
The achievable accuracy for measuring distances on scene objects (no CT scans) is 0.01mm. The
achievable accuracy of measuring distances on CT scans depends on the quality of the input data.
The achievable accuracy is additionally limited by 0.1 x maximum_voxel_size when mea-
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suring in isosurface or solid mode. When measuring distances of a CT scan to other scene objects,
the achievable accuracy additionally depends on the quality of the alignment.
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NOTE
The achievable accuracy for measuring angles on scene objects (no CT scans) is 0.5°. The achiev-
able accuracy of measuring angles on CT scans depends on the quality of the input data. When
measuring angles of the CT scan to other scene objects, the achievable accuracy additionally de-
pends on the quality of the alignment.
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WARNING
When measuring bone density, the loaded DICOM data set must be normalized to the Hounsfield
scale. If the loaded DICOM data set is not normalized to the Hounsfield scale, the measured values
will not represent a valid Hounsfield value.
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Type keywords (e.g., measurement name, words in the note field, measurement type, view type where the measurement was
taken) in the search bar at the top of the window 1} mor select a measurement type from the drop-down menu 2}mto filter
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the list. Click the button in the upper right 3 to remove all filters.
The following actions are available for each of the listed measurements:
Hide/show measurement 4}
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Alternatively, you can drag&drop the desired mesh into the main view. The Add/Remove Mesh window will be opened auto-
matically.
If you are loading a mesh of type implant planning generic collision object, you cannot complete the loading process if there
is a collision (see Chapter 27.5). You must resolve the collision before you can close the Add/Remove Mesh window.
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HINT
If no associated *.constructionInfo file could be loaded for a certain mesh type, exoplan displays a
message box that informs about the missing *.constructionInfo file. You should either check the
alignment after the import or reject the import and ensure that the *.constructionInfo file is avail-
able in the project folder and reload the mesh.
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Function Description
Correct height Change the mesh’s height position along the z-axis by
dragging it up/down
Set color Define the mesh’s color (color selection via Choose color
button)
Check Allow resizing to allow scaling the mesh. To scale the mesh, hold SHIFT and drag the mouse in the desired scaling
direction, indicated by a green arrow. To perform direction-based scaling, hold CTRL and SHIFT. Although this option is
available per default, you cannot scale all mesh types.
Check Show viewer axes to temporarily show the view axes. Three colored arrows are shown in the main view representing
the three view axes (red = x-axis, green = y-axis and blue = z-axis). The labels for each axis is written next to each arrow end
point.
Using Undo/Redo you can undo/redo mesh placement actions.
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Step 2: Select the mesh you want to delete. You can either select a mesh from the list or select All, All visible or None
using the corresponding buttons.
Step 3: Click OK.
You cannot delete the mesh the CT data is aligned to (see CT data alignment step, Chapter 9).
26.3 Annotations
You can add annotations to scene objects in the main view. You cannot create annotations in secondary views.
Clicking Annotations... in the Tools menu opens the Annotation editor window (see Figure 26.7).
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Select an annotation from the list and change the annotation text/color/font size/arrow length. You can link the font size to
the arrow length with the button to the right of the corresponding sliders.
To delete an annotation, click the recycle bin icon that appears to the right of the annotation name when you hover over it.
You cannot edit annotations created in the Measurement Tool (see Chapter 26.1).
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When hovering over the preview image in the top section of the Screen-
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Delete image 1}
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Edit image 4}m : The image is opened in Microsoft Paint. When you
save the image in Microsoft Paint, exoplan updates the preview im-
age. You can define another default image editing program in the
exoplan settings (see Chapter 26.7).
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Toggle fullscreen 5}
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You can select to include the image in the implant planning report and/or the surgical report by activating the corresponding
checkboxes below the image 6} m.
You can edit the caption of a preview image by double-clicking the field containing the auto-generated standard text 7}
m.
To change the order of the preview images, click on the image you want to move, hold the left mouse button for one second
and move the preview image to the desired position.
NOTE
If you selected at least one screenshot/image to be added to the planning report and/or sur-
gical report, exoplan displays a warning dialog before generating the planning report and/or
surgical output data which makes you aware of the screenshot(s)/image(s) and prompts you
to confirm that the image(s)/screenshot(s) are up to date regarding the planning situation.
A warning indicator appears in the Screenshot and Image Management window if
a screenshot/image is added to the planning report or surgical report after the corre-
sponding output data was created.
a screenshot/image was added to the planning report or surgical report but was removed,
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NOTE
Scan data that already has a defined insertion axis, an assigned construction, or an imported mar-
gin cannot be aligned to something else.
Click Align Meshes. This opens the Align Meshes window for the 3-point alignment (see Figure 26.13). Click alternating
points at same positions on the two meshes, as shown in Figure 26.12. exoplan displays the selected meshes in the Align
Meshes window as shown in 26.13.
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Check Show distance 5} mto display a color scale showing the remaining distance between the meshes (see Figure 26.14.
You can define an accepted and maximal distance.
The following functions help you improve the alignment result:
You can exclude mesh areas from best fit matching by checking Matching: Exclude selected parts 4}
m. This opens a Brush
tool window (see Figure 26.15).
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Hold the left mouse button and drag to paint areas to be excluded from the matching. They will be colored blue.
Mesh selection 1}
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Fit nowhere 2}
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Invert markings 3m
}: Marks unmarked areas vice versa.
Fit everywhere 4}
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Mark automatic 5}
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Radius for automatic marking 6m
}: Sets the radius of the mesh area at each arrow end.
Brush size 7}
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Brush inverse 8}
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You can select additional floating parts to be included in the alignment process by activating the checkbox Select additional
floating parts 1} m . This opens the Selected floating parts window (see Figure 26.16). Hovering over a mesh in the main
view will highlight it in the list of floating parts.
Select by click 6} mallows you to select individual parts by clicking them in the main view. Hold CTRL while clicking
to deselect a selected part.
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26.7 Settings
Click Settings in the tools menu to open the Settings window. In this window, you can view and change general settings for
your exoplan application. For applying certain changes, you must restart exoplan.
Setting Description
System Information Displays information on the exoplan installation and your computer system.
User interface theme Choose a theme for the exoplan user interface.
Background color for 3D view Choose a background color for the main view by clicking the + button. A set of
predefined colors is available. You can define your own background color using
RGB sliders. exoplan automatically saves a custom color as preset.
WARNING
Ensure good contrast and visibility when changing the background color.
Setting Description
Dental notation Tooth numbering system used in exoplan. FDI, Universal, Palmer or Palmer
(Digital) are available. Note that you need to restart exoplan after changing the
dental notation.
Let mouse cursor move on screen If activated, the mouse cursor moves while you right-click and drag to rotate an
while rotating object.
TruSmile on start Check this box if you have TruSmile installed, so it is active by default with the
launch of exoplan.
TruSmile-Lite (speed in favor of A rarely used option for old, slow graphics cards to increase the real-time
quality) responsiveness by decreasing the color accuracy.
Use Windows default cross hair A rarely used option for old, slow graphics cards to improve the quality of the
cursor cursor image.
Show ruler Check to display a mm/cm ruler on each side of the screen.
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Show grid Check to display a rectangular grid in the background of the main view, with
mm/cm markings on it.
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Setting Description
Allow sending of advanced Activate to allow exoplan to send advanced anonymous statistics to improve
statistics to improve products products and service. The statistics include:
The date and time when a surgical guide design was completed
Save a screenshot file When saving a scene file, exoplan automatically saves a screenshot preview
automatically for each saved image in the same folder.
scene
Cache implant library Enable to cache the implant and surgical guide component libraries for faster
loading times.
Default image editor Define the path of the default image editor to be used by the screenshot and
image management tool.
Activate incognito mode When activated, patient information is obscured in frequently used parts of the
user interface, e.g., in the DICOM Control. A button to toggle incognito mode is
displayed in the main toolbar.
Alignment iteration steps Defines the default value for the maximum number of iterations for the best fit
alignment in the CT-to-mesh workflow.
Default safety distance Use this slider to set the default safety distance.
Zip file password Set a password for zip files created by exoplan.
DICOM default search directory Define a default path under which the search for DICOM files should start when
the dialog box for loading DICOM data is displayed. If the path is not defined
(default), the search starts in the current project folder.
Generate combined mesh with Upon generating the planning result files, exoplan creates and saves a combined
planning result files mesh consisting of the used alignment object and the implant meshes.
Generate mandibular canal exoplan creates and saves nerve meshes upon creating the planning result files.
meshes with planning result files
Generate insertion channel exoplan creates and saves insertion channel meshes upon creating the planning
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Display safety distance in implant The implant planning report will display safety distances in the cross-sectional
planning report cross-sectional images.
images
Display bone level in implant The implant planning report will display the bone level in the cross-sectional
planning report cross-sectional images.
images
Skip loading of optical scans Skips the initial loading of an optical scan.
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Setting Description
Deleting planning result files Never/Always delete: Already generated planning result files will never/always
after altering sleeve setup be deleted if the sleeve setup is altered durig the implant planning workflow.
Default setting: Ask: exoplan displays a dialog prompting you to decide whether
you want to delete or keep the already generated planning result files.
Default edentulous guide design Select a default workflow for designing a tissue-supported surgical guide.
workflow
Prompt for density references If checked, exoplan will prompt you to define density references. If unchecked,
definition density references will be defined automatically.
Proposed insertion depth for Use this slider to set the proposed insertion depth for anchor pins.
anchor pins
Default fixation guide workflow Never/Always create fixation guide: exoplan will never/always initiate the
Workflow step to create a fixation guide. Default setting: Ask: exoplan displays
an option to create a fixation guide after merging the surgical guide.
Import virtual tooth extraction Specify whether exoplan should always import tooth extraction information
information from IPI file from IPI files or ask each time an IPI file is imported.
Set default program for file Opens a message box that explains how to change default programs for file
types types.
26.8 About
Click About in the tools menu to open the About window. The window shows information about the exoplan software:
product version, copyright information, engine build number, and dongle serial number (with option to copy to clipboard).
The About window also contains the Unique Device Identifier (UDI) as per regulation (EU) 2017/745 and 21 CFR 801.50 as
well as country-specific labeling information.
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27 Appendix
HINT
Please contact your reseller’s support in case an exception should occur.
If an exception dialog appears, stop your current work and close the application without saving the current state, as it may
contain corrupted data. If you continue working or save the current state, be aware that any generated output files (meshes,
XML files, PDF files, etc.) based on the further work or on the reloaded state may be corrupted. These files may contain wrong
information and construction, treatment, or surgery based on them may lead to unforeseeable patient risks (e.g., damaging
anatomical risk structures due to misplaced implants) and complications. To recover the current work, restart the application
and load a state that was saved before this dialog appeared or reload the project from scratch.
Image type: AXIAL or VOLUME, or other image types, e.g., REFORMATTED, if the DICOM dataset has user-accepted
issues (see Chapter 1.11.1)
Series date: date by when the series was recorded
For edentulous cases (Dual Scan Protocol), there are additional Patient, Study and Series entries. They contain the same
information about the loaded CT dataset of the prosthesis as listed above.
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NOTE
exoplan automatically defines axial and view direction. You can make manual adjustments in Ex-
pert mode.
27.4 Libraries
WARNING
Using a library not signed by exocad (delivered by a third party or another manufacturer) is made
at the risk of the user. exocad claims no warranty for cases which include libraries not signed by
exocad.
NOTE
If you loaded a scene file (see Chapter 3.1) with unsigned/blacklisted or locally missing libraries and
start the generation of the implant planning result files (see Chapter 17) or the surgical guide result
files (see Chapter 18.15), exoplan displays a warning dialog with an overview about these libraries
where you have to decide whether to continue or cancel the output generation.
In case of a missing drill protocol library in a loaded scene, you can decide to continue the surgical
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WARNING
If an implant library is updated, the implant parts of the previous library version used in saved
scenes will not be updated automatically. You must select the respective implant of the new
library version manually in the implant positioning step (see Chapter 16.2) after loading the
scene.
Not all implant parts available in the implant libraries might have regulatory clearance in your
country. Please verify the regulatory status with the respective implant manufacturer(s).
HINT
Contact your reseller for a complete list of available legally marketed implants for your geograph-
ical region.
27.5 Collisions
An implant can collide with other implants, anchor pins, mandibular nerves, and (generic) collision objects. You cannot cre-
ate planning result files if there is a collision. An exception to this is a collision between an invasive part (i.e., implants, anchor
pins) and a created sinus cavity collision object. In this case, you can decide to continue in the workflow at your own risk and
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Figure 27.1: Examples for a locally greater safety distance above the bone level (dotted line) with a defined safety distance of
2 mm.
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File Description
Planning info file Contains all information on the implant planning result necessary for importing the
.implantPlanningInfo result into another software (e.g., exocad DentalCAD). The planning info file is in XML
format and not encrypted.
Planning report PDF Overview of the planning result with all relevant information:
planningReport
Patient information
Project information
Panoramic radiograph images (with and without implants and drilling sleeves)
Scene file The current planning state when the planning result files are generated is saved as a
.implantPlanningScene scene file. This scene file can be loaded in exoplan.
Screenshot in .png format A screenshot of the saved scene is saved in the project directory.
.stl files stl meshes containing different coordinates (DICOM coordinates and/or scan
coordinates) are created for each implant. Which meshes are generated depends,
among other preconditions, on how you evaluated the alignment result in the CT data
alignment step (see Chapter 9.3.1). In addition to implant meshes, meshes of the
mandibular canal/s (if Generate mandibular canal meshes with planning result
files is activated in the exoplan settings, see Chapter 26.7) and a stl file for the DICOM
bounding box are created. For edentulous cases (Dual Scan Protocol), a stl mesh
extracted from the CT data of the prosthesis is created.
Checklist PDF List of generated stl files with hash values for verifying purposes.
SHA256Checklist
All planning result files will be stored in a zipped folder inside the project directory. Additionally, you can find the scene file
plus corresponding screenshot, the planning report PDF and the planning info file inside the project directory.
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All planning result filenames have the same prefix generation date (yyyymmdd)_generation time (hhmmss)_project name and
the same suffix -implantplan.
Example: Filename of PDF report for planning result generated March 1st 2016 at 2 PM, project name JohnDoe01.
Filename = 20160301_140000_JohnDoe01-planningReport-implantplan.pdf.
If the project includes implant planning in both jaws, the related jaw is also part of the filename. Date and time format in
filenames depend on the settings in your operating system.
exoplan is not tightly coupled to specific hardware, but can work together with all (dental) milling machines, 3D printers,
etc. that accept stl files.
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WARNING
Do not modify planning result files. Modifications of planning result files can cause damage to the
planning scene data and jeopardize the patient’s health and safety.
NOTE
Do not distribute output data from exoplan in case of a compromised or potentially compromised
PC workstation.
If there is a transformation matrix file in the project directory or a CT data alignment has already been performed, exoplan
prompts you to decide in which coordinate system you want to save the mesh (see Figure 27.2).
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27.10 Shortcuts
CTRL + Z / Y: Undo/Redo
ALT + F4: Close exoplan. You can still choose if you want to save the current scene.
Wizard windows
F1: Open user manual
CTRL + SPACE: Next
CTRL + BACKSPACE: Back
All windows
TAB: Switch to next tab
SHIFT + TAB: Switch to previous tab
CTRL + BACKSPACE: Back
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exoplan collects and categorizes all notifications that appear during the workflow session. You can display a history of all
notifications by clicking the notification icon in the upper right corner of the main view. You can filter saved notifications by
clicking Info 1}m , Warning 2} m , or Error 3} m . Copy a notification to your clipboard by clicking the corresponding icon 4}m .
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27.12 Troubleshooting
The DICOM data cannot be loaded.
Ensure that the DICOM data fulfills the requirements of the DICOM Conformance Statement. Only data sets that meet the
preconditions listed in 1.11.1 can be loaded. You can view the DICOM Conformance Statement by following this link.
The loaded DICOM data set shows a lot more of the anatomy than I would like to see.
Use the clipping function in the DICOM Control and cut the regions as required. See chapter 5.2 for details.
Why is it important to precisely align the optical scan to the DICOM data?
The positions of the implants are planned in relation to the anatomical information from the DICOM data of the patient (bone,
tooth roots, nerves, etc.). However, the surgical guide design will be based on the position and shape of the optical scan (i.e.,
jaw scan) or the prosthesis mesh (for an edentulous case). In order to place the implants precisely at the planned positions
during surgery, it is therefore crucial that the optical scan/prosthesis mesh and the DICOM data of the patient match as
precisely as possible during the planning process. Any offset between them will result in a respective misplacement of the
implants.
There are many scatters/artifacts in the DICOM data that make it difficult to align the DICOM data to the optical scan.
Use the tool for cropping the extracted CT mesh and cut away all the scattering. Furthermore, use the tool for marking
feature regions on the optical scan mesh and mark only areas where correspondent anatomical structures are clearly visible
and not masked by scattering in the DICOM data. See chapter 9.5 for details.
I want to use a special reference object (e.g., a Lego brick) in my alignment process and do not want to match the DICOM
data and the optical scan of the jaw directly.
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While in Expert mode, open Tools > Add/Remove mesh and load your reference object as CT alignment object. It will be
selectable as a target in the alignment step afterwards. Note that you must ensure the correct relative positioning between
jaw scan and reference object scan in this case.
The loaded DICOM data is displayed too bright/dark in the software and/or I want to adjust the contrast of the visual-
ization.
Adjust the brightness and contrast in the View tab of the DICOM Control window by adjusting the slider Current CT Data
window. For best results, view the adjustment in Solid mode. You can also select one of the windows defined in the DICOM
data set or manipulate the mentioned window by using shortcuts (SHIFT or CTRL + mouse wheel while the cursor is above
the cross-sectional view).
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In CT-to-CT alignment workflow (i.e., dual scan protocol) I have loaded the prosthesis CT data, but the software is not
able to align the patient and prosthesis CT data.
Make sure that the radio-opaque markers are detected correctly in both datasets. Mark or edit them manually if it is not
done automatically. Use the manual alignment tool in CT-to-CT alignment step (see Chapter 10.2.1) to correct the position of
the extracted prosthesis mesh.
I want to create a persistent measurement that will not change during the workflow.
You can create a persistent measurement by clicking the button Create annotation from current measurement in the
measurement tool (Tools > Measurement tool). See chapter 26.1 for a detailed description of the measurement tool.
Sinus segmentation fails with error messages (e.g., “segmentation is too big”)
Adjust the threshold to a lower value to ensure that the sinus cavity and its direct neighboring regions are not connected by
the threshold visualization in the secondary views. See also the Show more button.
During the workflow, I decided I want to plan more/less implants than originally intended.
Click Change implant setup In the Settings tab of the Implant positioning step, or open the Change Implant Setup win-
dow in Expert mode by clicking on Change Implant Setup in the main toolbar or the context menu. Here you can adjust the
amount/type of implants you want to plan.
After positioning implants, I noticed that the alignment between optical scan and DICOM data still needs to be im-
proved.
Switch to Expert mode and open the CT Data Alignment (CT-to-CT Data Alignment for edentulous cases) window by click-
ing on CT Data Alignment (CT-to-CT Data Alignment for edentulous cases) in the main toolbar or the context menu. All
movement applied to the DICOM data will also be applied to the parts depending on it (e.g., implants, nerves, ...). See Chapter
9 (Chapter 10 for edentulous cases) for details about the alignment steps.
The safety distance used during implant positioning is set too low/high each time I start planning a new case.
You can change the default value in the settings (Tools > Settings... > Default safety distance).
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The software displays an error/exception message when trying to access files on the hard drive, e.g., when writing output
data.
Ensure that the files the software tries to access have an access path shorter than 250 characters (technical limitation). If
the respective path is longer, please ask your reseller to reconfigure the software so that the file paths of the installation and
output files do not exceed the limit of 250 characters.
The step Merge and Save Surgical Guide stops with the message that the merging process failed.
Ensure that you only use signed drilling sleeve libraries. Afterwards, start the step Design Sleeve Mounts in Expert mode
and slightly adjust one of the parameter sliders. Restart the Merge and Save Surgical Guide step and make sure the merg-
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ing process can be finished. If the merging process still fails, keep adjusting the parameter sliders until the merging process
can be finished successfully. If the adjustment of the parameter sliders has no effect and the merging process still fails to
finish, start the step Add Attachments on Surgical Guide and slightly move any attachments that are present. Afterwards,
restart the step Merge and Save Surgical Guide and ensure the merging process can be finished.
Virtual tooth extraction: tooth is not correctly extracted (e.g, neighboring tooth is also extracted).
Use the functions in the tabs Margin or Correct to adjust the detected tooth border (see Chapter 21.4.1).
I want to learn more about exocad’s exoplan. Where can I find more information?
Visit exocad’s YouTube channel for recent exoplan tutorials. Ask your reseller for further training.
For all problems/solutions listed above: If the suggested solution fails, please contact your reseller.
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WARNING
Federal Law (USA) restricts the sale of this device to or on the order of a physician, dentist, or li-
censed practitioner.
WARNING
exoplan must only be used by qualified professionals. Using exoplan and surgical guide de-
sign and its features as well as the manufacturing of surgical guides without the necessary
medical knowledge in dentistry and professional diligence can lead to serious injuries of the
patient during the surgical implanting process, such as a permanent injury of the mandibular
nerve, a vessel, sinus, or healthy teeth.
exoplan must not be used by users with a physical handicap in color perception (e.g., color-
blind). exoplan users must be physically able to distinguish colors used for the display of ob-
jects (e.g., colors used for collisions and bone densities).
Good dental practice must be followed and the patient must be in a suitable and healthy con-
dition before starting the implant surgery (e.g., no periodontal disease on the patient’s denti-
tion).
WARNING
Ensure to use only the recommended hardware, drivers, operating system, and software applica-
tions (e.g., PDF reader), such as graphics adapter, and that your graphics and monitor settings as
well as the light conditions of your work environment are configured in an optimal way.
WARNING
It is suggested to use the version of the graphics adapter driver that was current when exoplan was
released. Furthermore, disable automatic driver updates to avoid newer drivers that could have
potential negative side effects to the performance and stability of exoplan. Modification and/or
exoplan.3.1_User_Manual_en, 2023–07–04
corruption of the software installation may lead to dangerous results in the implant planning pro-
cess and the design of a surgical guide with hazardous impact for the surgical implanting process.
WARNING
Ensure that the DICOM series has a sufficient spatial resolution, an acceptable accuracy, and is not
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WARNING
The relevant anatomical structures must be sufficiently visible in the 3D CT data to proceed with
implant planning. e.g., the mandibular nerve must be visible in the mandible. In maxillae, the an-
terior palatine nerve and the maxillary sinus floor must be visible. Insufficiently visible anatomical
structures in the 3D CT data may lead to an erroneous planning process and thus may cause per-
manent injury of the patient.
WARNING
When loading a DICOM series and an optical scan, ensure that the series and the scan belong
to the same and current patient.
Ensure that the data quality of optical scans used in exoplan is sufficient for implant planning.
WARNING
Make sure that the optical scan is based on a recent physical model and/or was recorded recently.
Scans based on outdated information may not fit the patient’s anatomical situation or lead to in-
juries, complications, or additional surgery.
WARNING
Wrong visualization settings for the DICOM series may lead to undesired results of the implant
planning process with the consequence of seriously injuring the patient (mandibular nerve, sinus,
healthy tooth) in the surgical implanting procedure.
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WARNING
When alignment with the CT data is done using a particular alignment object which is not the jaw
scan, the user is responsible for assuring that the jaw scan used for surgical guide design is in cor-
rect relative geometrical position to the used alignment object.
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WARNING
Aligning CT data is a sensitive process which must be performed accurately. This process includes
appropriate isosurface value settings, the accurate placement of points during the 3-point align-
ment step (see Chapter 9.2), and, if applicable, appropriate cropping of the CT mesh (see Chapter
21.5.2) and appropriate marking of feature regions (see Chapter 9.5.2). The alignment accuracy is
directly connected to the accuracy of surgical guides created from the jaw scan.
WARNING
If you perform the CT data alignment step after model teeth have been loaded or positioned, an-
notations have been added, or collision objects have been loaded, you must decide if these should
be transformed (see Chapter 9.4).
WARNING
If you perform the CT-to-CT data alignment step after annotations have been added or colli-
sion objects have been loaded, you must decide if these should be transformed (see Chapter
10.1.2).
In order to be able to mark the gingiva contact surface of a prosthesis correctly, it is essential
to use the proper threshold settings when extracting the patient’s prosthesis.
WARNING
An incorrect definition of the mandibular nerve can cause a permanent injury of the patient
during the surgical implanting procedure.
Skipping the process of defining the mandibular nerve canal might cause injury to the patient,
e.g., resulting in permanent impairment of the nerve.
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WARNING
An incorrect definition of the sinus cavity can cause a permanent injury of the patient during
the surgical implanting procedure.
Skipping the process of defining the sinus cavity can cause a permanent injury of the patient
during the surgical implanting procedure.
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WARNING
An incorrect density threshold value definition can impede the recognition of suboptimal implant
positions.
WARNING
Verify the correctness of the position and shape of the panoramic curve before proceeding in the
workflow.
WARNING
exoplan does not verify if you have placed an implant at an eligible position for the selected
tooth number.
When selecting an implant for a particular tooth location make sure that the intended use/the
indications of the implant allows the usage for the respective tooth and purpose.
WARNING
Ensure that the correct implant type including platform type / platform length and diameter is
selected according to the clinical situation of the patient. Pay particular attention to this when
planning an implant case near a major anatomical feature such as arteries or alveolar nerve.
WARNING
During implant positioning, ensure the feasibility of the surgery for the particular implant position.
Consider the existing dentition and study the insertion channels for the respective implant.
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WARNING
A safety distance below 1.5 mm should only be used in exceptional cases with particular care.
Consider increasing the safety distance for the collision detection to compensate for the de-
creased precision of the surgical guide when working with edentulous patients in the dual
scan workflow.
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WARNING
When you have selected a freely positionable drilling sleeve, exoplan does not automatically
select a compatible surgical kit and respective tools. This responsibility fully remains with
the user.
The displayed drill depth is approximated from the geometric mesh provided by the manu-
facturer of the respective implant.
The distance of the sleeve shoulder to the implant’s apical peak is calculated based on the
implant mesh provided by the implant manufacturer. In case this mesh does not perfectly
represent the real physical implant geometry, there will be a deviation.
WARNING
The implant planning report shows information regarding which anchor pins are used/placed
but neither the implant planning report nor the surgical report will detail information about
the drill (length/diameter) to use.
When a library with anchor pins is updated, the parts of the previous version of the updated
library in saved scenes are not updated automatically. To update them in the scene, the im-
plant positioning step must start again with subsequent confirming to update the libraries.
WARNING
Please note that manufactured surgical guides for endosseous dental implant placement are clas-
sified as medical devices by the FDA, regulated under 21 CFR 872.3980. As such, they are subject to
legal requirements such as registration and listing as a manufacturer of medical devices, validation
of production equipment/processes and quality system regulations.
WARNING
Verify the surgical guide manufacturing process and the surgical guide before using it for the
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treatment of patients.
When the surgical guide bridges over multiple missing teeth, make sure that the solid fit of the
surgical guide is still ensured and that it does not bend or is not tilted under load. In particular,
this applies for multiple missing canine and incisors.
When designing a surgical guide for edentulous cases or partially edentulous cases, use an-
chor pins to guarantee a stable fit of the surgical guide.
Make sure that the design of the surgical guide does not contain sharp edges, ridges, or peaks
to avoid injuries of the patient’s soft tissue such as the tongue.
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WARNING
The Minimum Base Thickness of a sleeve mount/anchor pin mount is a crucial parameter for
the stability of a surgical guide. If the value is too low, the surgical guide may bend or break
under load. Please regard that a suitable value for the minimum thickness is dependent on
the material intended for surgical guide manufacturing.
Hint: Check the minimum requirements specified by the material manufacturer and ask your
reseller if you are in doubt.
Use the Clearance Above function with care and choose a value appropriate for the selected
tools for surgery.
The Radial sleeve offset value is dependent on the material/printer combination used for
surgical guide manufacturing and requires experience with used material and equipment.
Wrong settings result in ill-fitting sleeves in the surgical guide.
WARNING
The Offset value in the Block out Undercuts section is dependent on the material/printer com-
bination used for surgical guide manufacturing and requires experience with used material and
equipment. Wrong settings result in an ill-fitting surgical guide.
WARNING
Carefully inspect the impact of a particular setting of the insertion direction (e.g., blocking or al-
lowing undercuts or smoothing of the bottom). Inappropriate settings may result in an ill-fitting
surgical guide.
WARNING
Insufficient connection of the surgical guide top to the sleeve mount may cause the surgical
guide to bend or break during the surgical procedure.
For tooth-supported surgical guides, do not include soft tissue (e.g., gingiva) in the design of
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the surgical guide top while defining the surgical guide top margin line.
WARNING
Use the attachment function with care because it may impact the stability and fit of the surgical
guide.
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WARNING
Use the Free-Form tool with care because it may impact the stability and fit of the surgical guide.
WARNING
In the US, the physical surgical guide for endosseous dental implant placement is a medical device
to be manufactured at an FDA registered and listed manufacturing location. Please contact the
FDA for information regarding the regulatory status and requirements related to manufacturing
these surgical guides.
WARNING
Verify the surgical guide before usage.
WARNING
Validate the surgical report document before commencing the surgical procedure.
Do not modify the files created for the manufacturing of the surgical guide.
You must carefully study the surgical report.
WARNING
Ensure that all scene objects necessary for evaluating a scene are activated for visualization in the
Group Selector.
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WARNING
When measuring distances in secondary views, be aware of the limitations of measurements in a
2D image plane within 3D space, e.g., when measuring a distance between two objects.
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WARNING
When measuring bone density, the loaded DICOM data set must be normalized to the Hounsfield
scale. If the loaded DICOM data set is not normalized to the Hounsfield scale, the measured values
will not represent a valid Hounsfield value.
WARNING
Ensure good contrast and visibility when changing the background color.
WARNING
Using a library not signed by exocad (delivered by a third party or another manufacturer) is made
at the risk of the user. exocad claims no warranty for cases which include libraries not signed by
exocad.
WARNING
If an implant library is updated, the implant parts of the previous library version used in saved
scenes will not be updated automatically. You must select the respective implant of the new
library version manually in the implant positioning step (see Chapter 16.2) after loading the
scene.
Not all implant parts available in the implant libraries might have regulatory clearance in your
country. Please verify the regulatory status with the respective implant manufacturer(s).
WARNING
Do not modify planning result files. Modifications of planning result files can cause damage to the
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planning scene data and jeopardize the patient’s health and safety.
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